Provider Demographics
NPI:1992172803
Name:CONNORS, KELLY ANN MADELINE (CSA)
Entity type:Individual
Prefix:
First Name:KELLY ANN
Middle Name:MADELINE
Last Name:CONNORS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3104 E CAMELBACK RD # 1035
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4502
Mailing Address - Country:US
Mailing Address - Phone:480-772-2453
Mailing Address - Fax:480-452-1123
Practice Address - Street 1:3940 E CRITTENDEN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3660
Practice Address - Country:US
Practice Address - Phone:480-772-2453
Practice Address - Fax:480-452-1123
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
AZRN196173163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No163W00000XNursing Service ProvidersRegistered Nurse