Individual
KELLY D CHAVEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1729 N TREKELL RD, SUITE 124, CASA GRANDE, AZ 85222
(520) 421-7100
Mailing address
2285 CORPORATE CIR, STE 200, HENDERSON, NV 89074-7759
(702) 360-2763
(949) 783-2880
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4885
AZ
363A00000X
Physician Assistant
PA06592
TX
363A00000X
Physician Assistant
PA2004-0001
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11435577
—
NM
01
—
P00990161
RR MEDICARE - AZ CASA GRANDE
AZ
Enumeration date
01/09/2006
Last updated
09/13/2016
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