Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kelsi Madelyn Kocmoud, PA-C

Individual provider Physician Assistant · NPI 1770031403

Kelsi Madelyn Kocmoud, PA-C is a Physician Assistant in Peoria, Arizona. Qualified in 2021, 5 years ago. Practices with Banner Physician Specialists Arizona LLC, a 372-clinician group and accepts Medicare assignment.

Years since qualifying
5
In the registry since
2016
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

13943 N 91st Ave Ste B101
Peoria, AZ 85381-3688
Phone: (623) 476-5390
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1770031403
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 12, 2016
Last updated in NPPESSeptember 17, 2022
Certification dateJune 14, 2022

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Banner Physician Specialists Arizona Llc — 372 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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