Provider Demographics
NPI:1336601210
Name:DORMAN, KATHERINE JOY (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOY
Last Name:DORMAN
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-1010
Mailing Address - Country:US
Mailing Address - Phone:915-351-6600
Mailing Address - Fax:623-777-6004
Practice Address - Street 1:11202 W JOBLANCA RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:623-920-2720
Practice Address - Fax:623-777-6004
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily