Provider Demographics
NPI:1184053035
Name:MCDEVITT, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 EAST RIVER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5984
Mailing Address - Country:US
Mailing Address - Phone:520-293-5757
Mailing Address - Fax:520-293-7358
Practice Address - Street 1:1595 E RIVER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5981
Practice Address - Country:US
Practice Address - Phone:520-293-5757
Practice Address - Fax:520-293-7358
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5474363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical