Kellie M Earle P.a., PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3636 Issued in AZ

Practice address

4135 So. Power Rd
Suite 129
Mesa, AZ 85212

Phone

(480) 751-3091

Fax

(480) 751-3095

NPI assigned

Jul 23, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Blair T Butterfield, PC

  • Family Medicine Physician
  • Gilbert, AZ
  • NPI 1922031566
  NPD (past)

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

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460592000000",
    "number": "1891995296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1156 SO FERN CT",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85296",
            "telephone_number": "480-751-3091",
            "fax_number": "480-751-3095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4135 SO. POWER RD",
            "address_2": "SUITE 129",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85212",
            "telephone_number": "480-751-3091",
            "fax_number": "480-751-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EARLE P.A.",
        "first_name": "KELLIE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-23",
        "last_updated": "2016-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "3636",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "010832",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eagle Eye Medical Transportation
• Eagles View Counseling and Family Services
• Jarod Eagles, D.C.
• Zachary Earhart, PHARMD
• Earl P. Duffy DDS PC
• Darcy Rae Easley
• East Mesa Dental Partners, LLP
• East Mesa Family Doctors PLLC
• East Mesa Medical Center
• East Mesa Pediatrics, Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; 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.