MEDICARE: MS. KATHERINE HANNAH LEARY PA-C

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	363AM0700X	Medical Physician Assistant	AZ2848	AZ
2	363A00000X	Physician Assistant	AZ2848	AZ

General Provider Information

NPI Number	:	1871671792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE HANNAH LEARY PA-C

Provider Business Mailing Address
First Line	:	7725 N 43RD AVE STE 720
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5772
Country	:	US
Telephone Number	:	623-207-5465
Fax Number	:	623-207-5405

Provider Business Practice Location Address
First Line	:	7725 N 43RD AVE STE 720
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5772
Country	:	US
Telephone Number	:	623-207-5465
Fax Number	:	623-207-5405

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/23/2022

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