Provider Demographics
NPI:1508858754
Name:CATON, KENNETH B (PA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:B
Last Name:CATON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1447
Mailing Address - Country:US
Mailing Address - Phone:928-684-1833
Mailing Address - Fax:
Practice Address - Street 1:520 ROSE LN
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1447
Practice Address - Country:US
Practice Address - Phone:286-841-8339
Practice Address - Fax:623-523-6581
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2897363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00356648Medicare PIN
AZZ111976Medicare PIN
Q13008Medicare UPIN
AZZ111975Medicare PIN