Healthcare Provider Details

I. General information

NPI: 1235069014
Provider Name (Legal Business Name): KC GAFFNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9842 E IRWIN CIR
MESA AZ
85209-7083
US

IV. Provider business mailing address

9842 E IRWIN CIR
MESA AZ
85209-7083
US

V. Phone/Fax

Practice location:
  • Phone: 505-288-5806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-26074
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: