Healthcare Provider Details

I. General information

NPI: 1700867876
Provider Name (Legal Business Name): KATHLEEN A. CAHOON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N 4TH ST
FLAGSTAFF AZ
86004-1816
US

IV. Provider business mailing address

PO BOX 3630
FLAGSTAFF AZ
86003-3630
US

V. Phone/Fax

Practice location:
  • Phone: 928-213-6100
  • Fax: 928-774-4808
Mailing address:
  • Phone: 928-233-5110
  • Fax: 928-774-6687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001684
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4279
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: