OrganizationActive
Ageless Living Institute LLC
NPI 1770160269 · Medical Physician Assistant · Prescott, AZ
Provider details
- NPI number
- 1770160269
- Entity type
- Organization
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Mark Kledzik, Member(928) 255-5191
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
- Neurological Surgery Physician207T00000X
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
- Physician Assistant363A00000X
Physician Assistants & Advanced Practice Nursing Providers
Practice location
1670 Willow Creek Rd Ste a
Prescott, AZ 86301-1112
Phone: (928) 255-5191
Fax: (928) 316-9703
Approximate (ZIP-level) locationGet directions
Mailing address
1670 Willow Creek Rd Ste a
Prescott, AZ 86301-1112
Registry dates
- Enumerated
- 2021-03-29
- Last updated
- 2023-02-02
- Certified
- 2023-02-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.