Provider Demographics
NPI:1265654180
Name:ICE, KRISTI KRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:KRISTINE
Last Name:ICE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4605 SOUTH PRIEST DRIVE
Mailing Address - Street 2:LOT 291
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-695-0469
Mailing Address - Fax:602-482-4640
Practice Address - Street 1:3933 EAST EDNA
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:602-569-5437
Practice Address - Fax:602-482-4640
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AZ3098363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical