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General NPI Number Information
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NPI Number | 1124644182
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Entity Type | Individual
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Provider Name | KIERSTIN LEALIIEE
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Gender | Female
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 6410 S KINGS RANCH RD STE 1
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City | GOLD CANYON
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State | AZ
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Zip | 85118-7352
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Country | US
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Telephone | 480-761-2500
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Fax | 480-288-2879
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Provider Business Mailing Address
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Address Line | 219 N 2940 E
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City | ST GEORGE
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State | UT
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Zip | 84790-7096
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Country | US
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Telephone | 602-489-1313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2437
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 11959125-1206
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10838
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License Number State | AZ
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