Provider Demographics
NPI:1265573810
Name:HAWORTH, KATHERINE AZAR (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AZAR
Last Name:HAWORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:502 W LAS PALMARITAS DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5535
Mailing Address - Country:US
Mailing Address - Phone:602-222-9111
Mailing Address - Fax:602-277-5111
Practice Address - Street 1:5056 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1521
Practice Address - Country:US
Practice Address - Phone:602-222-9111
Practice Address - Fax:602-277-5111
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant