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General NPI Number Information
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NPI Number | 1699745885
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Entity Type | Individual
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Provider Name | JENNIFER SHAY KISER PAC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 4611 E SHEA BLVD STE 190
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City | PHOENIX
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State | AZ
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Zip | 85028-4259
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Country | US
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Telephone | 480-889-0180
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Fax | 480-889-0186
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Provider Business Mailing Address
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Address Line | 4611 E SHEA BLVD BLDG 3 SUITE 170
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City | PHOENIX
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State | AZ
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Zip | 85028-4254
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Country | US
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Telephone | 480-889-0180
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Fax | 480-889-0186
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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 | 2667
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License Number State | AZ
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