Provider Demographics
NPI:1194571216
Name:BAILEY, KENDALL O'CONNER (PA-C)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:O'CONNER
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 W ROMO JONES ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5311
Mailing Address - Country:US
Mailing Address - Phone:831-359-1267
Mailing Address - Fax:
Practice Address - Street 1:6644 E BASELINE RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4439
Practice Address - Country:US
Practice Address - Phone:480-844-0510
Practice Address - Fax:480-844-1663
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical