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NPI Code Detail

MEDICARE: KYNETIC HEALTH, PLLC

MEDICARE: KYNETIC HEALTH, PLLC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1477179372
Entity Type Code : Organization
Provider Name (Legal Business Name) : KYNETIC HEALTH, PLLC
Provider Business Mailing Address
First Line : 3533 CANYON DE FLORES STE A
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85650-5366
Country : US
Telephone Number : 520-231-1050
Fax Number :
Provider Business Practice Location Address
First Line : 3533 CANYON DE FLORES STE A
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85650-5366
Country : US
Telephone Number : 520-685-3336
Fax Number : 520-685-3846
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : ANN LEBECK
Credential :
Telephone Number : 808-321-0567
Provider Enumeration Date : 06/17/2020
Last Update Date : 09/29/2021

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