Healthcare Provider Details

I. General information

NPI: 1891656534
Provider Name (Legal Business Name): KATHERINE ANNE FETTER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W CAMELBACK RD
PHOENIX AZ
85017-3030
US

IV. Provider business mailing address

2962 E MARLENE DR
GILBERT AZ
85296-9458
US

V. Phone/Fax

Practice location:
  • Phone: 330-421-0991
  • Fax: 330-421-0991
Mailing address:
  • Phone: 330-421-0991
  • Fax: 330-421-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number221057
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221057
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: