Individual
KYRIE JAE NICOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
26224 N TATUM BLVD STE 15A, PHOENIX, AZ 85050-7500
(486) 663-9632
(623) 748-1914
Mailing address
26224 N TATUM BLVD, PHOENIX, AZ 85050-7500
(480) 663-9632
(480) 419-6782
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11229
AZ
Other
Enumeration date
07/25/2023
Last updated
10/13/2025
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