Healthcare Provider Details

I. General information

NPI: 1902192784
Provider Name (Legal Business Name): KATRINA M SPRADLING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 04/16/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 W OLIVE AVE STE 102
GLENDALE AZ
85302-3147
US

IV. Provider business mailing address

PO BOX 417
PEORIA AZ
85380-0417
US

V. Phone/Fax

Practice location:
  • Phone: 623-387-3705
  • Fax: 623-439-7467
Mailing address:
  • Phone: 623-387-3705
  • Fax: 866-941-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3720
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: