MEDICARE: CATE JACKSON DNP, PMHNP-BC

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
1	163W00000X	Registered Nurse	RN185172	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	223507	AZ

General Provider Information

NPI Number	:	1750849469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATE JACKSON DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	10439 S 51ST ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5224
Country	:	US
Telephone Number	:	480-635-9944
Fax Number	:

Provider Business Practice Location Address
First Line	:	10439 S 51ST ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5224
Country	:	US
Telephone Number	:	480-635-9944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	12/06/2023

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