Provider Demographics
NPI:1346912821
Name:BERTRAND, KALEY MELISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:MELISSA
Last Name:BERTRAND
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Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4135 S POWER RD STE 129
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3627
Mailing Address - Country:US
Mailing Address - Phone:480-751-3091
Mailing Address - Fax:480-751-3095
Practice Address - Street 1:4135 S POWER RD STE 129
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3627
Practice Address - Country:US
Practice Address - Phone:480-751-3091
Practice Address - Fax:480-751-3095
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2024-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ9474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant