Provider Demographics
NPI:1407897853
Name:CHACON, KARI SUSAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:SUSAN
Last Name:CHACON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 W MCDOWELL RD
Mailing Address - Street 2:#2087
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85035-4881
Mailing Address - Country:US
Mailing Address - Phone:623-518-6129
Mailing Address - Fax:
Practice Address - Street 1:4550 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1708
Practice Address - Country:US
Practice Address - Phone:623-846-7597
Practice Address - Fax:623-846-1826
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3391363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical