Provider Demographics
NPI:1902192784
Name:SPRADLING, KATRINA M (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:M
Last Name:SPRADLING
Suffix:
Gender:F
Credentials:FNP-C
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 417
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85380-0417
Mailing Address - Country:US
Mailing Address - Phone:623-387-3705
Mailing Address - Fax:866-941-5662
Practice Address - Street 1:5700 W OLIVE AVE STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3147
Practice Address - Country:US
Practice Address - Phone:623-387-3705
Practice Address - Fax:623-439-7467
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ638403Medicaid
AZZ146727Medicare PIN