Provider Demographics
NPI:1700852928
Name:PACKER, KATHRYN JOY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:JOY
Last Name:PACKER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:FLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:14478 W WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2035
Mailing Address - Country:US
Mailing Address - Phone:602-320-4818
Mailing Address - Fax:623-320-4818
Practice Address - Street 1:14478 W WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2035
Practice Address - Country:US
Practice Address - Phone:602-320-4818
Practice Address - Fax:623-320-4818
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1240363LF0000X
FLAPRN11022406363LF0000X
COC-APN.0004221-C-NP363LF0000X
AZAP7236363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health