Provider Demographics
NPI:1861828832
Name:KLEIN, KELLY LEIGH (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEIGH
Last Name:KLEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4550 E BELL RD STE 170
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9385
Mailing Address - Country:US
Mailing Address - Phone:480-443-8400
Mailing Address - Fax:480-443-8697
Practice Address - Street 1:5111 N SCOTTSDALE RD STE 203
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7077
Practice Address - Country:US
Practice Address - Phone:480-771-3400
Practice Address - Fax:602-753-3042
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-22
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI164362-30163W00000X
AZAP11189363LG0600X
AZTAP11189363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty