Healthcare Provider Details

I. General information

NPI: 1043360753
Provider Name (Legal Business Name): CATHERINE A KEFER ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 LANDMARK LN
PRESCOTT AZ
86301-0019
US

IV. Provider business mailing address

PO BOX 910221
DALLAS TX
75391-3011
US

V. Phone/Fax

Practice location:
  • Phone: 971-262-9600
  • Fax:
Mailing address:
  • Phone: 520-519-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-006279
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number201250065NP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number290917
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: