Provider Demographics
NPI:1821651753
Name:MARTINEZ, KATIE MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MICHELLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MICHELLE
Other - Last Name:MYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:39821 N THUNDER HILLS LN
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3697
Mailing Address - Country:US
Mailing Address - Phone:623-225-8997
Mailing Address - Fax:
Practice Address - Street 1:39821 N THUNDER HILLS LN
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3697
Practice Address - Country:US
Practice Address - Phone:623-225-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN173331163W00000X
AZ229940363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse