Provider Demographics
NPI:1518081397
Name:ROUNTREE, CATHERINE R (FNP)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:R
Last Name:ROUNTREE
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 DRAWER PH
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:928-674-7001
Mailing Address - Fax:928-674-7705
Practice Address - Street 1:OFF HWY 191 HOPITAL ROAD
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7001
Practice Address - Fax:928-674-7705
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN054773163W00000X
NMR40380363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ746654Medicaid
AZ8HZH64Medicare ID - Type UnspecifiedMEDICARE PART B - PINON
AZ8HZH74Medicare ID - Type UnspecifiedMEDICARE PART B - TSAILE
AZ746654Medicaid
AZ8HZH54Medicare ID - Type UnspecifiedMEDICARE PART B - CHINLE