Individual provider Active NPI

Kiersten Mackenzie Proehl, PA-C

  • Medical Physician Assistant
  • Avondale, AZ
National Provider Identifier
1912823618
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
11872 Issued in AZ
Practice address
3400 N Dysart Rd Ste G127
Avondale, AZ 85392-1011
Phone
(623) 322-0323
Fax
(623) 322-0757
NPI assigned
Jun 26, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 11872 AZ Primary

Addresses

Primary practice location

3400 N Dysart Rd Ste G127
Avondale, AZ 85392-1011

Mailing address

3400 N Dysart Rd Ste G127
Avondale, AZ 85392-1011
Phone (623) 322-0323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2026
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3400 N Dysart Rd
Suite G127
Avondale, AZ 85392-1011

PO Box
Suite 234
Gilbert, AZ 85299-0234

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1782432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782432000000",
    "number": "1912823618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 N DYSART RD STE G127",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853921011",
            "telephone_number": "623-322-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 N DYSART RD STE G127",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853921011",
            "telephone_number": "623-322-0323",
            "fax_number": "623-322-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROEHL",
        "first_name": "KIERSTEN",
        "middle_name": "MACKENZIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-06-26",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "11872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avondale, AZ

Sources for this page

Verify at the official NPI Registry.