MEDICARE: KEREN JANE LEFFORD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601002486	MI
2	363AM0700X	Medical Physician Assistant	4448	AZ
3	363AS0400X	Surgical Physician Assistant	5601002486	MI
4	363AS0400X	Surgical Physician Assistant	4448	AZ
5	363A00000X	Physician Assistant	0010-03654	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003815846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEREN JANE LEFFORD PA

Provider Business Mailing Address
First Line	:	10330 N SCOTTSDALE RD
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253-1427
Country	:	US
Telephone Number	:	602-255-7625
Fax Number	:	602-255-7630

Provider Business Practice Location Address
First Line	:	10330 N SCOTTSDALE RD
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253
Country	:	US
Telephone Number	:	602-255-7625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	06/07/2018

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Directions to “ KEREN JANE LEFFORD PA” Practice Location

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