Provider Demographics
NPI:1821080821
Name:O'NAN, KEVIN A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:O'NAN
Suffix:
Gender:M
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 1:2875 W RAY RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3524
Mailing Address - Country:US
Mailing Address - Phone:480-899-3070
Mailing Address - Fax:
Practice Address - Street 1:2875 W RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3524
Practice Address - Country:US
Practice Address - Phone:480-899-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2926363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ824418Medicaid
Q04450Medicare UPIN
AZ103790Medicare ID - Type Unspecified