Healthcare Provider Details

I. General information

NPI: 1649959792
Provider Name (Legal Business Name): CARLEY MICHELLE ABBOTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E OSBORN RD STE 250
PHOENIX AZ
85014-5699
US

IV. Provider business mailing address

PO BOX 81064
CLEVELAND OH
44181-0064
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-9161
  • Fax: 602-265-1823
Mailing address:
  • Phone: 520-795-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9798
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: