Organization
LEADING EDGE HEALTHCARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB KIRKEENG PA-C (OWNER MEMBER)
(928) 925-2871
Entity
Organization
Contact information
Practice address
724 N MONTEZUMA ST STE A, PRESCOTT, AZ 86301-2066
(928) 925-2871
Mailing address
2182 MARK AVE, PRESCOTT, AZ 86301-1029
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
05/05/2022
Last updated
03/22/2023
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