KENDAL PACKER (NPI# 1023566817) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023566817 |
| Entity Type | Individual |
| Full Name | KENDAL PACKER |
| Practice Address |
3306 W Roosevelt St Phoenix AZ 85009-3404 |
| Mailing Address |
4220 N 20th Ave Phoenix AZ 85015-5124 |
| Practice Telephone | 6022784930 |
| Mailing Telephone | 6028899401 |
| Mailing Fax Number | 6028899404 |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2020-09-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 184512 | 05 | |
| AZ | MEDICARE | Z194890 | 01 |
| Street Address |
3306 W ROOSEVELT ST |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85009-3404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588635643 | James Lea Ali | Physician Assistant | 3306 W Roosevelt St, Phoenix, AZ 85009-3404 | 2006-01-27 |
| 1922644012 | Elicia Hinton | Family Medicine | 3306 W Roosevelt St, Phoenix, AZ 85009-3404 | 2019-11-23 |
| 1265981666 | Your Neighborhood Dental Care LLC | Dentist | 3306 W Roosevelt St, Phoenix, AZ 85009-3404 | 2016-09-26 |
| 1356792410 | Melissa Morrison | Nurse Practitioner | 3306 W Roosevelt St, Ste. A, Phoenix, AZ 85009-3404 | 2016-06-29 |
| 1336455450 | Robin K Lee | Physician Assistant | 3306 W Roosevelt St, Phoenix, AZ 85009-3404 | 2010-08-26 |
| 1548597941 | Sag, LLC | Pain Medicine | 3306 W Roosevelt St, Phoenix, AZ 85009-3404 | 2009-11-06 |
| 1033359419 | Sag, LLC | Clinic/Center | 3306 W Roosevelt St, Phoenix, AZ 85009-3404 | 2009-02-25 |
| 1245423789 | Family Practice Clinic Ltd | Family Medicine | 3306 W Roosevelt St, Ste A, Phoenix, AZ 85009-3404 | 2007-08-18 |
| 1699828723 | Charles Eugene Myers | Family Medicine | 3306 W Roosevelt St, Suite A, Phoenix, AZ 85009-3404 | 2007-01-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083220065 | Ashley Medeiros | Specialist/Technologist | 2926 E. Encanto Blvd., Phoenix, AZ 85009 | 2020-09-16 |
| 1326252909 | Raul Herreras | Speech-Language Pathologist | 3101 W. Mcdowell Road, Phoenix, AZ 85009 | 2007-05-10 |
| 1295956779 | Gerardo Gaerlan Gregorio | Internal Medicine | 3250 W. Lower Buckeye Road, Phoenix, AZ 85009 | 2007-05-01 |
| 1316060338 | Eve Ronnie Davidson | Registered Nurse | 3333wroosevelt, Phoenix, AZ 85009 | 2007-04-06 |
| 1679693808 | Paul Thomas Lorentsen | Internal Medicine | 1929 W. Fillmore St, Bldg C, The Neighborhood Christian Clinic, Phoenix, AZ 85009 | 2007-03-30 |
| 1134246655 | Audrea J Chambers-pryce | Registered Nurse | 3715 W Roosevelt, Phx, AZ 85009 | 2007-03-22 |
| 1053437582 | Monique Marie Knepper | Licensed Practical Nurse | 3025 W Mc Dowell Rd, Phoenix, AZ 85009 | 2007-03-22 |
| 1245356054 | Lena Rose Felder | Speech-Language Pathologist | 3348 W. Mcdowell Rd., Phoenix, AZ 85009 | 2007-03-22 |
| 1508900036 | Walter M Wood | Psychologist | 3348 W Mcdowell Road, Phoenix, AZ 85009 | 2007-02-17 |
| 1194869982 | Maureen Brukardt | Registered Nurse | 3449 N 39th Ave, Phx, AZ 85009 | 2007-02-16 |
| Find all providers in zip 85009 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407456585 | Chelsea Lee Townsend | Physician Assistant | 6823 S 9th Ave, Phoenix, AZ 85041-6752 | 2020-10-28 |
| 1972100949 | Amanda Alcantar | Physician Assistant | 8822 W Minnezona Ave, Phoenix, AZ 85037-1499 | 2020-10-02 |
| 1700483898 | Athena Marie Arbuckle | Physician Assistant | 3815 E Bell Rd Ste 3600, Phoenix, AZ 85032-2166 | 2020-10-02 |
| 1356957062 | Kylee Ann Lattomus | Physician Assistant | 26008 N 47th Dr, Phoenix, AZ 85083-1681 | 2020-09-17 |
| 1841801768 | Pfai Assist, Pllc | Physician Assistant | 10645 N Tatum Blvd Ste 200-556, Phoenix, AZ 85028-3068 | 2020-08-13 |
| 1285242479 | Jacob Molina | Physician Assistant | 15820 N 21st Dr, Phoenix, AZ 85023-7268 | 2020-07-14 |
| 1649898602 | Rivi Rose Sacks | Physician Assistant | 776 E Circle Rd, Phoenix, AZ 85020-4142 | 2020-07-07 |
| 1942828876 | Taylor Leblanc | Physician Assistant | 2150 W Alameda Rd Unit 1343, Phoenix, AZ 85085-1941 | 2020-07-07 |
| 1730707746 | Emily Jane Foley | Physician Assistant | 4650 N Central Ave Unit 241, Phoenix, AZ 85012-1076 | 2020-07-07 |
| 1841815230 | Alyssa Nicole Bruns | Physician Assistant | 4217 E Altadena Ave, Phoenix, AZ 85028-2232 | 2020-06-10 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.