Individual
KERRY KNIEVEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
240 W THOMAS RD, SUITE 400, PHOENIX, AZ 85013-4407
(602) 406-6262
(602) 406-6260
Mailing address
240 W THOMAS RD # 400, PHOENIX, AZ 85013-4407
(602) 406-6262
(602) 406-6261
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
005732
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005732
MEDICAL LICENSE
AZ
05
—
726415
—
AZ
Enumeration date
11/30/2007
Last updated
09/17/2018
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