Individual
KELLIE MARIE LIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4360 E BROWN RD STE 113, MESA, AZ 85205-4084
(480) 964-0080
Mailing address
4946 W ELECTRA LN, GLENDALE, AZ 85310-3839
(408) 410-0645
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6984
AZ
Other
Enumeration date
03/30/2018
Last updated
05/03/2018
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