Provider Demographics
NPI:1265692982
Name:PRESTON, KATE (MD)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:PRESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:77 W FOREST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1479
Mailing Address - Country:US
Mailing Address - Phone:928-773-2222
Mailing Address - Fax:928-773-2598
Practice Address - Street 1:77 W FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:928-773-2222
Practice Address - Fax:928-773-2598
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51189208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1265692982OtherAETNA
AZ1265692982OtherAFMC
AZ111828Medicaid
AZ1265692982OtherCIGNA
AZ1265692982OtherUHC
AZ1265692982OtherBCBS
AZ1265692982OtherHUMANA
AZ1265692982OtherHEALTH NET
AZ1265692982OtherHMN