Individual
KENDAL PACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10238 E HAMPTON AVE STE 404, MESA, AZ 85209-3319
(480) 771-7546
Mailing address
4220 N 20TH AVE, PHOENIX, AZ 85015-5124
(602) 889-9401
(602) 889-9404
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184512
—
AZ
01
—
Z194890
MEDICARE
AZ
Enumeration date
09/21/2016
Last updated
04/07/2025
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