Provider Demographics
NPI:1356957062
Name:LATTOMUS, KYLEE ANN (MMS, PA-C)
Entity type:Individual
Prefix:MISS
First Name:KYLEE
Middle Name:ANN
Last Name:LATTOMUS
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Gender:F
Credentials:MMS, PA-C
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Mailing Address - Street 1:18444 N 25TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:623-474-3696
Mailing Address - Fax:623-544-5531
Practice Address - Street 1:1840 N JASPER DR STE 2
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1634
Practice Address - Country:US
Practice Address - Phone:866-974-2673
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2024-03-26
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Provider Licenses
StateLicense IDTaxonomies
AZ8068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant