Healthcare Provider Details

I. General information

NPI: 1790258614
Provider Name (Legal Business Name): BRITTANY LEE CALLAHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE STE 102
PHOENIX AZ
85027-4014
US

IV. Provider business mailing address

6722 W WESTCOTT DR
GLENDALE AZ
85308-5748
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-3354
  • Fax:
Mailing address:
  • Phone: 480-559-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060564
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA004793
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7380
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: