Provider Demographics
NPI:1568290054
Name:KELLY, BROOKE E (PA-C)
Entity type:Individual
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First Name:BROOKE
Middle Name:E
Last Name:KELLY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:16220 N SCOTTSDALE RD STE 600
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1804
Mailing Address - Country:US
Mailing Address - Phone:480-306-6949
Mailing Address - Fax:602-302-5706
Practice Address - Street 1:2502 E CAMELBACK RD STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-9315
Practice Address - Country:US
Practice Address - Phone:480-306-6949
Practice Address - Fax:602-302-5706
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant