Provider Demographics
NPI:1912322207
Name:IRWIN, KATHRYN MEREDITH (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MEREDITH
Last Name:IRWIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 BUFFALO TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-3751
Mailing Address - Country:US
Mailing Address - Phone:928-699-1593
Mailing Address - Fax:
Practice Address - Street 1:2625 N KING ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1884
Practice Address - Country:US
Practice Address - Phone:928-679-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily