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NPI Code Detail

MEDICARE: KATHRYN HAUSOTTER

MEDICARE: KATHRYN HAUSOTTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician009060AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235664236
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN HAUSOTTER
Provider Business Mailing Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-0008
Country : US
Telephone Number : 602-933-3124
Fax Number :
Provider Business Practice Location Address
First Line : 800 COVE PKWY
Second Line :
City : COTTONWOOD
State : AZ
Zip : 86326-4644
Country : US
Telephone Number : 928-649-3003
Fax Number : 928-649-3030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2017
Last Update Date : 04/08/2026

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Directions to “ KATHRYN HAUSOTTER ” Practice Location

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