Healthcare Provider Details

I. General information

NPI: 1841495470
Provider Name (Legal Business Name): KACY LEE GARFIELD RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 N LYNX LAKE DR
PRESCOTT VALLEY AZ
86314-2465
US

IV. Provider business mailing address

6070 E ANTELOPE LN
PRESCOTT VALLEY AZ
86314-2701
US

V. Phone/Fax

Practice location:
  • Phone: 928-710-4361
  • Fax:
Mailing address:
  • Phone: 928-710-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number155574 19
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: