Provider Demographics
NPI:1598998890
Name:MINOR, KATHERINE ANNE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ANNE
Last Name:MINOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1331 N 7TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2779
Mailing Address - Country:US
Mailing Address - Phone:602-277-6181
Mailing Address - Fax:602-256-9138
Practice Address - Street 1:1331 N 7TH STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2779
Practice Address - Country:US
Practice Address - Phone:602-277-6181
Practice Address - Fax:602-256-9138
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ144700Medicare UPIN