Provider Demographics
NPI:1497142988
Name:RATH, KAITLYN LARAY (FNP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LARAY
Last Name:RATH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:480-855-2224
Mailing Address - Fax:480-398-8080
Practice Address - Street 1:8880 E DESERT COVE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6746
Practice Address - Country:US
Practice Address - Phone:480-314-6670
Practice Address - Fax:480-257-1997
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300326363LG0600X
AZAG08170183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology