Healthcare Provider Details

I. General information

NPI: 1568290054
Provider Name (Legal Business Name): BROOKE E KELLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E CAMELBACK RD STE 160
PHOENIX AZ
85016-9315
US

IV. Provider business mailing address

16220 N SCOTTSDALE RD STE 600
SCOTTSDALE AZ
85254-1804
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-6949
  • Fax: 602-302-5706
Mailing address:
  • Phone: 480-306-6949
  • Fax: 602-302-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: