Provider Demographics
NPI:1962829713
Name:BRADY, KATHLEEN POSPISIL (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:POSPISIL
Last Name:BRADY
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 1:840 E MCKELLIPS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-9654
Mailing Address - Country:US
Mailing Address - Phone:602-491-0703
Mailing Address - Fax:833-429-2070
Practice Address - Street 1:12100 N DYSART RD STE 105
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-3308
Practice Address - Country:US
Practice Address - Phone:602-491-0703
Practice Address - Fax:833-464-2520
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32300265163WD0400X
AZAP5393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAPRN 2081OtherHAWAII STARE LICENSE