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NPI Code Detail

MEDICARE: KYLIE STAVA

MEDICARE: KYLIE STAVA
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
1390200000XStudent in an Organized Health Care Education/Training ProgramAZ

General Provider Information

NPI Number : 1477304988
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLIE STAVA
Provider Business Mailing Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-0945
Fax Number :
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-0945
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2024
Last Update Date : 04/01/2026

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Directions to “ KYLIE STAVA ” Practice Location

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