Physician Assistant, Medical
AGELESS LIVING INSTITUTE LLC
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1770160269 · enumerated 2021-03-29 · record updated 2023-02-02. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: Mr. MARK KLEDZIK, Member · (928) 255-5191
Addresses and phones
- Practice location 1670 WILLOW CREEK RD STE A, PRESCOTT, AZ, 86301-1112 (928) 255-5191 Fax (928) 316-9703 Google Maps Apple Maps OpenStreetMap
- Mailing address 1670 WILLOW CREEK RD STE A, PRESCOTT, AZ, 86301-1112 (928) 255-5191 Fax (928) 316-9703 Google Maps Apple Maps OpenStreetMap
Specialties
- Internal Medicine 207R00000X
- Neurological Surgery 207T00000X
- Physical Medicine & Rehabilitation 208100000X
- Physical Medicine & Rehabilitation, Pain Medicine 2081P2900X
- Physician Assistant 363A00000X
- Physician Assistant, Surgical 363AS0400X
- Physician Assistant, Medical 363AM0700X · Primary
In this directory
Locations and evidence
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Practice location
PRESCOTT, AZ, 863011112
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.