Individual
JASMINE DOMINIQUE KALILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14520 W GRANITE VALLEY DR STE 210, SUN CITY WEST, AZ 85375-5855
(866) 974-2673
(866) 939-2673
Mailing address
18444 N 25TH AVE STE 310, PHOENIX, AZ 85023-1266
(669) 742-6738
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2601001358
MI
363A00000X
Physician Assistant
Primary
9570
AZ
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162801
—
AZ
01
—
2000017753
BOARD OF CERTIFICATION
—
01
—
2601001358
MI DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
06/14/2017
Last updated
08/13/2025
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