Kelly Anne Soares, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7523 Issued in AZ

Practice address

9819 N 95TH St Ste 105
Scottsdale, AZ 85258-4588

Phone

(480) 874-2229

NPI assigned

Nov 2, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kelly Bramen-Sodahl Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Valley Ear, Nose & Throat Associates, P.C

  • Otolaryngology Physician
  • Glendale, AZ
  • NPI 1164287652
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1083126809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9819 N 95TH ST STE 105",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584588",
            "telephone_number": "480-874-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9819 N 95TH ST STE 105",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584588",
            "telephone_number": "480-874-2229"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3805 E Bell Rd Ste 5800",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850322190",
            "country_code": "US",
            "telephone_number": "602-688-6500",
            "fax_number": "602-867-3144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOARES",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-02",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "363A00000X",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "BRAMEN-SODAHL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Paul D Snyder Jr., M.D.
• Paul Jay Snyder, FNP
• Sarah Snyder
• Shane Daniel Snyder, DPT
• So Vein Phlebotomy & Diagnostic'S
• Skyler Soares, FNP-C
• Jacek Sobczak, M.D.
• Marcia Harrer Sobek, DDS
• Talia Helen Sobel, MD
• Sanja Sobo, MC., LPC

• Physician Assistant in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.