Healthcare Provider Details

I. General information

NPI: 1659798056
Provider Name (Legal Business Name): KENDRA LYNN MASON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA LYNN REILLY PA-C

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W UTOPIA RD STE 100
PHOENIX AZ
85027-4172
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4000
  • Fax:
Mailing address:
  • Phone: 615-329-2294
  • Fax: 615-695-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9120274
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number6040
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5603
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: