Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacqueline Kienholz, PA

Individual provider Medical Physician Assistant · NPI 1649618356

Jacqueline Kienholz, PA is a Physician Assistant in Gilbert, Arizona. Qualified in 2012, 14 years ago. Practices with Banner Cancer Center Specialists LLC, a 338-clinician group and accepts Medicare assignment. Licensed in Arizona and California.

Years since qualifying
14
Licensed in
AZ, CA
In the registry since
2013
Specialties on file
4
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Partly verified

Some contact details are missing from the federal record.

Banner Md Anderson Cancer Center 2946 E Banner Gateway Dr
Gilbert, AZ 85234
Phone: (480) 256-6444
Fax: (480) 256-3682
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Oncology Physician (primary) Taxonomy 2086X0206X · Licence 5467 (AZ)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA22903 (CA)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 5467 (AZ)
Family Health Clinical Nurse Specialist Taxonomy 364SF0001X · Licence PA22903 (CA)

Record details

NPI number1649618356
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 5, 2013
Last updated in NPPESMarch 18, 2020
Certification dateMarch 18, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Banner Cancer Center Specialists Llc — 338 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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