Provider Demographics
NPI:1114322237
Name:GILBERT, KATHERINE R (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:GILBERT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20414 N 27TH AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3250
Mailing Address - Country:US
Mailing Address - Phone:520-539-2631
Mailing Address - Fax:855-282-8920
Practice Address - Street 1:20414 N 27TH AVE FL 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3250
Practice Address - Country:US
Practice Address - Phone:520-539-2631
Practice Address - Fax:855-282-8920
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627148363L00000X
AZ228255363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114322237OtherNPI
AZ228255OtherNP
TX8464NQOtherUPIN
TX621748OtherNURSE LICENSE