Healthcare Provider Details

I. General information

NPI: 1790982965
Provider Name (Legal Business Name): KATHERINE BEDDALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S 6TH ST
COTTONWOOD AZ
86326-4236
US

IV. Provider business mailing address

1090 COMMERCE DR
PRESCOTT AZ
86305-3700
US

V. Phone/Fax

Practice location:
  • Phone: 928-639-8130
  • Fax: 928-639-8179
Mailing address:
  • Phone: 928-771-3122
  • Fax: 928-771-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN103722
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: