Healthcare Provider Details

I. General information

NPI: 1275467607
Provider Name (Legal Business Name): KATHRYN KARTCHNER RD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 E BASELINE RD STE 116
MESA AZ
85204-7288
US

IV. Provider business mailing address

3048 E BASELINE RD STE 116
MESA AZ
85204-7288
US

V. Phone/Fax

Practice location:
  • Phone: 480-745-9977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: