| Kyle Maxum, | |
|
Corner Of Route N12 And N7, Fort Defiance, AZ 86504 | |
| (928) 729-8000 | |
| Not Available |
| Full Name | Kyle Maxum |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | Corner Of Route N12 And N7, Fort Defiance, Arizona |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225805211 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 363A00000X | Physician Assistant | PA.0008848 (Colorado) | Primary |
| Entity Name | The Fort Defiance Indian Hospital Board, Incorporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1477876639 PECOS PAC ID: 0941336697 Enrollment ID: O20100429001153 |
| Mailing Address | Practice Location Address |
|---|---|
| Kyle Maxum, Po Box 649, Fort Defiance, AZ 86504-0649 Ph: Not Available | Kyle Maxum, Corner Of Route N12 And N7, Fort Defiance, AZ 86504 Ph: (928) 729-8000 |
Pony Nancy Sokiri, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: Corner Of Route N12 And N7, Corner Of Route N12 And N7, Fort Defiance, AZ 86504 Phone: 928-729-8000 |
Andrew Yosim, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: Corner Of Route N12 And N7, Fort Defiance, AZ 86504 Phone: 928-729-8000 |
Roanne Jimenez, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: Corner Of Route N12 And N7, Fort Defiance, AZ 86504 Phone: 928-729-8000 |
Miriam Christine Rollason, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: Corner Of Route N12 And N7, Fort Defiance, AZ 86504 Phone: 928-729-8000 |
Ms. Tessa Tahereh Facer, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: Corner Of Route N12 And N7, Fort Defiance, AZ 86504 Phone: 928-729-8000 |
Ceairra Torres Beck, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: Corner Of Route N12 & N7, Fort Defiance, AZ 86504 Phone: 928-729-8431 |
Charlotte Thompson, P.A.-C. Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: Corner Of Route N12 And N7, Fort Defiance, AZ 86504 Phone: 928-729-8000 |