Provider Demographics
NPI:1982139804
Name:PACIORA, KAYLEE ANN (PA-C, RDN)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ANN
Last Name:PACIORA
Suffix:
Gender:F
Credentials:PA-C, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 E CAVEDALE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-8764
Mailing Address - Country:US
Mailing Address - Phone:480-244-6960
Mailing Address - Fax:
Practice Address - Street 1:7701 W ASPERA BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7947
Practice Address - Country:US
Practice Address - Phone:623-248-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8822363A00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered