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AGELESS LIVING INSTITUTE LLC
NPI 1770160269
Physician Assistant - Medical in Prescott, AZ

Active since March 29, 2021
1670 WILLOW CREEK RD STE A, PRESCOTT, AZ 86301(928) 255-5191(928) 316-9703 Get Directions Write a Review

NPPES record last updated: February 2, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 2, 2023, Nov 16, 2022, Mar 29, 2021 (3 updates tracked since 2021).

About Ageless Living Institute Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AGELESS LIVING INSTITUTE LLC (NPI 1770160269) is a healthcare organization registered as a medical in Prescott, Arizona and active in the NPI registry since March 2021. The organization lists Mark Joseph Kledzik, Member, as its authorized official.

NPPES Registry Identity

NPI1770160269
Entity TypeOrganization
Primary Taxonomy363AM0700X
Legal Business NameAGELESS LIVING INSTITUTE LLC
Location Address1670 WILLOW CREEK RD STE APrescott, AZ 86301-1112
Mailing Address1670 Willow Creek Rd Ste APrescott, AZ 86301-1112 · (928) 255-5191 · Fax (928) 316-9703
Phone(928) 255-5191
Fax(928) 316-9703
Organization SubpartNo
Authorized OfficialMark Joseph KledzikMember · (928) 255-5191
Enumeration DateMarch 29, 2021
Last NPPES UpdateFebruary 2, 20233 updates tracked since enumeration
NPPES CertifiedFebruary 2, 2023
✔ NPI 1770160269 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 7

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedNeurological SurgeryTaxonomy 207T00000X
Also ListedPhysical Medicine & RehabilitationTaxonomy 208100000X
Also ListedPhysical Medicine & Rehabilitation · Pain MedicineTaxonomy 2081P2900X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedPhysician Assistant · SurgicalTaxonomy 363AS0400X
1670 WILLOW CREEK RD STE A, Prescott, AZ 86301
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Other Identifiers 1

Medicaid1437452836AZ

Group Practice 2

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. DELMAS LEE ABBOTT PA-C
Physician Assistant (Medical)
1670 WILLOW CREEK RD STE A
PRESCOTT, AZ 86301
Yavapai County (928) 255-5191
LESLEY E WOOD D.O.
Hospitalist
1670 WILLOW CREEK RD STE A
PRESCOTT, AZ 86301
Yavapai County (928) 515-0632

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ageless Living Institute LLC's NPI number?

The NPI number for Ageless Living Institute LLC is 1770160269. It was assigned to this organization in the NPPES registry on March 29, 2021.

Where is Ageless Living Institute LLC located?

Ageless Living Institute LLC is located at 1670 Willow Creek Rd Ste A, Prescott, AZ 86301. The listed phone number is (928) 255-5191.

What is Ageless Living Institute LLC's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Ageless Living Institute LLC was last updated on February 2, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.