MEDICARE: KRISTIN E PETCHER 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	085006442	IL

General Provider Information

NPI Number	:	1821596552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN E PETCHER PA

Provider Business Mailing Address
First Line	:	4530 E MUIRWOOD DR STE 111
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7693
Country	:	US
Telephone Number	:	480-961-2365
Fax Number	:	480-961-2382

Provider Business Practice Location Address
First Line	:	4530 E MUIRWOOD DR STE 111
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7693
Country	:	US
Telephone Number	:	480-961-2365
Fax Number	:	480-961-2382

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

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	02/10/2026

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