Provider Demographics
NPI:1700867876
Name:CAHOON, KATHLEEN A (DO)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:CAHOON
Suffix:
Gender:F
Credentials:DO
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 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-233-5110
Mailing Address - Fax:928-774-6687
Practice Address - Street 1:2920 N 4TH ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1816
Practice Address - Country:US
Practice Address - Phone:928-213-6100
Practice Address - Fax:928-774-4808
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2001684207Q00000X
AZ4279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000183520OtherANTHEM
IN200051890AMedicaid
AZ705608Medicaid
10780767OtherCAQH
AZ705608Medicaid
IN200051890AMedicaid