Provider Demographics
NPI:1003815846
Name:LEFFORD, KEREN JANE (PA)
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:JANE
Last Name:LEFFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KEREN
Other - Middle Name:JANE
Other - Last Name:LEFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10330 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1427
Mailing Address - Country:US
Mailing Address - Phone:602-255-7625
Mailing Address - Fax:602-255-7630
Practice Address - Street 1:10330 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253
Practice Address - Country:US
Practice Address - Phone:602-255-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002486363A00000X, 363AS0400X
AZ4448363AM0700X, 363AS0400X
NC0010-03654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003815846Medicaid
SC2368PAMedicaid
NCNC8376BMedicare PIN
NC1003815846Medicaid
NCNC8376DMedicare PIN
MIN86750002Medicare UPIN
NCNC8376GMedicare PIN
SC2368PAMedicaid
NCNC8376FMedicare PIN
NCNC8376CMedicare PIN
MIN88100020Medicare PIN
MIC37626047Medicare PIN