Provider Demographics
NPI:1164961355
Name:BROWN, KATHLEEN (RT (R)(CT), ARRT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RT (R)(CT), ARRT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:KOGUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT (R)(CT), ARRT
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:YUCCA
Mailing Address - State:AZ
Mailing Address - Zip Code:86438-0867
Mailing Address - Country:US
Mailing Address - Phone:928-514-9016
Mailing Address - Fax:
Practice Address - Street 1:14226 CALABASAS ROAD
Practice Address - Street 2:
Practice Address - City:YUCCA
Practice Address - State:AZ
Practice Address - Zip Code:86438
Practice Address - Country:US
Practice Address - Phone:928-514-9016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ468530247100000X
AZCTCT-310072471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist