Healthcare Provider Details

I. General information

NPI: 1215590138
Provider Name (Legal Business Name): KAYLEE LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLEE NEWSOME PA-C

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 E AGAVE RD STE 148
PHOENIX AZ
85044-0623
US

IV. Provider business mailing address

PO BOX 61025
PHOENIX AZ
85082-1025
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-7546
  • Fax:
Mailing address:
  • Phone: 480-681-3300
  • Fax: 480-681-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8114
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: