Individual
KRYSTEN PROVENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13555 W MCDOWELL RD STE 200, GOODYEAR, AZ 85395-2624
(480) 756-6000
(855) 636-8770
Mailing address
2222 S DOBSON RD STE 305, MESA, AZ 85202-6490
(480) 756-6000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10672
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
AZ
Other
Enumeration date
12/08/2023
Last updated
10/09/2024
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