Kellie Marie Lim, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6984 Issued in AZ

Practice address

4360 E Brown Rd Ste 113
Mesa, AZ 85205-4084

Phone

(480) 964-0080

NPI assigned

Mar 30, 2018

Last updated

May 3, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1522368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525305600000",
    "number": "1831695824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4946 W ELECTRA LN",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853103839",
            "telephone_number": "408-410-0645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4360 E BROWN RD STE 113",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852054084",
            "telephone_number": "480-964-0080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4946 W Electra Ln",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853103839",
            "country_code": "US",
            "telephone_number": "408-410-0645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIM",
        "first_name": "KELLIE",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-30",
        "last_updated": "2018-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lighthouse Support Services LLC
• Daisy Hannah Liljenquist, PA
• Loren Edgar Lilly, RRT
• Christine Lillywhite, M.S., MT-BC
• Alice Lim, DDS
• Ruth T. Lim, M.D.
• Tracy Thao Thach Lin, PHARMD
• Erinn Lind
• Philip Lindblom
• Ryk W Linden, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; 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.