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General NPI Number Information
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NPI Number | 1891995296
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Entity Type | Individual
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Provider Name | KELLIE M EARLE P.A. PA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 4135 SO. POWER RD SUITE 129
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City | MESA
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State | AZ
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Zip | 85212
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Country | US
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Telephone | 480-751-3091
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Fax | 480-751-3095
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Provider Business Mailing Address
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Address Line | 1156 SO FERN CT
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City | GILBERT
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State | AZ
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Zip | 85296
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Country | US
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Telephone | 480-751-3091
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Fax | 480-751-3095
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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 | 3636
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License Number State | AZ
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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 | 010832
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License Number State | NY
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