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NPI Code Detail

MEDICARE: MS. ANGELA CHANNELLE KISELYK

MEDICARE: MS. ANGELA CHANNELLE KISELYK
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
1363AM0700XMedical Physician Assistant3091AZ

General Provider Information

NPI Number : 1912058694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELA CHANNELLE KISELYK
Provider Business Mailing Address
First Line : 102 WOODMONT BLVD STE 600
Second Line :
City : NASHVILLE
State : TN
Zip : 37205-5250
Country : US
Telephone Number : 888-987-1151
Fax Number :
Provider Business Practice Location Address
First Line : 4315 E MAIN ST
Second Line :
City : MESA
State : AZ
Zip : 85205-8605
Country : US
Telephone Number : 480-870-7500
Fax Number : 480-906-2173
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 06/06/2025

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Directions to “ MS. ANGELA CHANNELLE KISELYK ” Practice Location

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