Provider Demographics
NPI:1790258614
Name:CALLAHAN, BRITTANY LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEE
Last Name:CALLAHAN
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 1:6722 W WESTCOTT DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5748
Mailing Address - Country:US
Mailing Address - Phone:480-559-2696
Mailing Address - Fax:
Practice Address - Street 1:5757 W THUNDERBIRD RD STE 151
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4641
Practice Address - Country:US
Practice Address - Phone:602-865-4570
Practice Address - Fax:602-865-4575
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004793363A00000X
PAMA060564363A00000X
AZ7380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant