Kelly Jackson

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

AP4200 Issued in AZ

Legal business name

KELLY JACKSON

Practice address

9345 E Voltaire Ave
Scottsdale, AZ 85260-7432

Phone

(214) 227-2457

Fax

(214) 764-0880

NPI assigned

Mar 10, 2015

Last updated

Mar 10, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly Jackson, NP

Title

Owner

Phone

(214) 227-2457

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425945600000",
    "number": "1831582204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9345 E VOLTAIRE AVE",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852607432",
            "telephone_number": "214-227-2457",
            "fax_number": "214-764-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9345 E VOLTAIRE AVE",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852607432",
            "telephone_number": "214-227-2457",
            "fax_number": "214-764-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-10",
        "last_updated": "2015-03-10",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-227-2457",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "AP4200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Kellershabrokh, D.O.
• Catherine Leslie Kelley, PHARM.D.
• Daniel J Kelley, M.D.
• Rachel Virginia Kelley, PHYSICIAN ASSISTANT
• Virginia Kelley, L.C.S.W.
• Leslee Friedman Kelly-Cashdan, MD
• Bridget Anne Kelly
• David Alexander Kelly, M.D.
• Gemini Kelly
• Grace Catherine Kelly, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.