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NPI Code Detail

MEDICARE: CATHY KELLEY PA

MEDICARE: CATHY KELLEY 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
1363A00000XPhysician Assistant1133AZ

Other Identifiers

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

General Provider Information

NPI Number : 1053303396
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHY KELLEY PA
Provider Business Mailing Address
First Line : 15650 N BLACK CANYON HWY
Second Line : SUITE 100
City : PHOENIX
State : AZ
Zip : 85053-4064
Country : US
Telephone Number : 602-866-0550
Fax Number : 602-993-5788
Provider Business Practice Location Address
First Line : 2030 W WHISPERING WIND DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85085-2853
Country : US
Telephone Number : 602-866-0550
Fax Number : 602-993-5788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 08/22/2011

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Directions to “ CATHY KELLEY PA” Practice Location

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