Provider Demographics
NPI:1619580461
Name:KLEIN, KELLIE JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:JEAN
Last Name:KLEIN
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 1:3300 N 7TH AVE UNIT 404
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4190
Mailing Address - Country:US
Mailing Address - Phone:949-444-1359
Mailing Address - Fax:
Practice Address - Street 1:8415 N PIMA RD STE 290
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4488
Practice Address - Country:US
Practice Address - Phone:480-434-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant