Provider Demographics
NPI:1952364333
Name:BAGWELL, KATHLEEN E (CSFA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:BAGWELL
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Gender:F
Credentials:CSFA
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Mailing Address - Street 1:2925 E RIGGS RD STE 8-166
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4199
Mailing Address - Country:US
Mailing Address - Phone:602-909-4623
Mailing Address - Fax:480-895-8417
Practice Address - Street 1:2925 E RIGGS RD STE 8-166
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-4199
Practice Address - Country:US
Practice Address - Phone:602-909-4623
Practice Address - Fax:480-895-8417
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2022-01-06
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical