Healthcare Provider Details

I. General information

NPI: 1982515508
Provider Name (Legal Business Name): ANNIE ELAINA ESHELMAN-KAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17722 N 79TH AVE APT 1029
GLENDALE AZ
85308-8670
US

IV. Provider business mailing address

17722 N 79TH AVE APT 1029 APT 1029
GLENDALE AZ
85308-8670
US

V. Phone/Fax

Practice location:
  • Phone: 480-212-0825
  • Fax: 888-838-5149
Mailing address:
  • Phone: 480-212-0825
  • Fax: 888-838-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-331062
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: