Active NPI
Kristi Kristine Ice, PA-C
- Medical Physician Assistant
- Phoenix, AZ
National Provider Identifier
1265654180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 3098
- Practice address
- 3933 East Edna
Suite 102
Phoenix, AZ 85032 - Phone
- (602) 569-5437
- Fax
- (602) 482-4640
- NPI assigned
- May 2, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3098 | AZ | Primary |
Addresses
Primary practice location
3933 East Edna
Suite 102
Phoenix, AZ 85032
Mailing address
4605 South Priest Drive
Lot 291
Tempe, AZ 85282
Phone (480) 695-0469
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3098 | AZ | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Utah Valley Pediatrics L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- Provo, UT
- NPI 1497812721
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265654180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4605 SOUTH PRIEST DRIVE",
"address_2": "LOT 291",
"city": "TEMPE",
"state": "AZ",
"postal_code": "85282",
"telephone_number": "480-695-0469",
"fax_number": "602-482-4640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3933 EAST EDNA",
"address_2": "SUITE 102",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85032",
"telephone_number": "602-569-5437",
"fax_number": "602-482-4640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICE",
"first_name": "KRISTI",
"middle_name": "KRISTINE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "3098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.