Provider Demographics
NPI:1245525914
Name:FLAGSTAFF FIRST ASSIST, PLLC
Entity type:Organization
Organization Name:FLAGSTAFF FIRST ASSIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KYPTA
Authorized Official - Suffix:
Authorized Official - Credentials:NP, RNFA
Authorized Official - Phone:928-714-9379
Mailing Address - Street 1:2050 E CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-9328
Mailing Address - Country:US
Mailing Address - Phone:928-714-9379
Mailing Address - Fax:
Practice Address - Street 1:2050 E CHISHOLM TRL
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-9328
Practice Address - Country:US
Practice Address - Phone:928-714-9379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ180806OtherMEDICARE
AZRN105443OtherRNFA