Provider Demographics
NPI:1598581282
Name:KICKSTART PSYCHIATRY
Entity type:Organization
Organization Name:KICKSTART PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:ILIEFF
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:480-979-0827
Mailing Address - Street 1:2325 E CAMELBACK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3514
Mailing Address - Country:US
Mailing Address - Phone:480-979-0827
Mailing Address - Fax:480-210-8294
Practice Address - Street 1:2325 E CAMELBACK RD STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3514
Practice Address - Country:US
Practice Address - Phone:480-979-0827
Practice Address - Fax:480-210-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty