Healthcare Provider Details

I. General information

NPI: 1336059468
Provider Name (Legal Business Name): KATHIANA MARIE JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W BASELINE RD STE 101
MESA AZ
85202-9098
US

IV. Provider business mailing address

1855 W BASELINE RD STE 101
MESA AZ
85202-9098
US

V. Phone/Fax

Practice location:
  • Phone: 888-224-2087
  • Fax:
Mailing address:
  • Phone: 888-224-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9574748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: