Provider Demographics
NPI:1033725437
Name:SHACKLETON, KAYLA (PA)
Entity Type:Individual
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First Name:KAYLA
Middle Name:
Last Name:SHACKLETON
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Gender:F
Credentials:PA
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Mailing Address - Street 1:3805 E BELL RD STE 3100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2136
Mailing Address - Country:US
Mailing Address - Phone:602-494-3656
Mailing Address - Fax:602-867-3862
Practice Address - Street 1:19646 N 27TH AVE STE 408
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4028
Practice Address - Country:US
Practice Address - Phone:602-867-8644
Practice Address - Fax:602-606-5128
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-10-24
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant