Healthcare Provider Details

I. General information

NPI: 1477179372
Provider Name (Legal Business Name): KYNETIC HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 CANYON DE FLORES STE A
SIERRA VISTA AZ
85650-5366
US

IV. Provider business mailing address

3533 CANYON DE FLORES STE A
SIERRA VISTA AZ
85650-5366
US

V. Phone/Fax

Practice location:
  • Phone: 520-685-3336
  • Fax: 520-685-3846
Mailing address:
  • Phone: 520-231-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANN LEBECK
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 808-321-0567