Provider Demographics
NPI:1417335647
Name:KIMES, KATHRYN (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KIMES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 E DEER VALLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7452
Mailing Address - Country:US
Mailing Address - Phone:480-454-4185
Mailing Address - Fax:
Practice Address - Street 1:7312 E DEER VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7452
Practice Address - Country:US
Practice Address - Phone:480-454-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1417335647207RI0200X
AZ007687207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program