Provider Demographics
NPI:1962726778
Name:METZ, KELLY (PA-C, MPH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:METZ
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:PO BOX 6730
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6730
Mailing Address - Country:US
Mailing Address - Phone:480-821-3610
Mailing Address - Fax:480-821-3610
Practice Address - Street 1:7342 E THOMAS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7243
Practice Address - Country:US
Practice Address - Phone:480-917-6480
Practice Address - Fax:480-857-2667
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant