Provider Demographics
NPI:1326559568
Name:KIM, MELISSA JOY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JOY
Last Name:KIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6627 W BENT TREE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7525
Mailing Address - Country:US
Mailing Address - Phone:623-695-4430
Mailing Address - Fax:
Practice Address - Street 1:15396 N 83RD AVE STE E
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5627
Practice Address - Country:US
Practice Address - Phone:480-561-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant