Individual
KAELYN TKACIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
44870 W HATHAWAY AVE STE 6, MARICOPA, AZ 85139-9600
(480) 214-9000
(480) 214-9999
Mailing address
44870 W HATHAWAY AVE STE 6, MARICOPA, AZ 85139-9600
(480) 214-9000
(480) 214-9999
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8695
AZ
363A00000X
Physician Assistant
—
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/05/2021
Last updated
09/24/2025
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