Healthcare Provider Details

I. General information

NPI: 1386507804
Provider Name (Legal Business Name): KMA MEDICAL AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 COMMERCE CENTER CIR STE C
PRESCOTT AZ
86301-7410
US

IV. Provider business mailing address

13215 N TRAIL BLAZER DR
PRESCOTT AZ
86305-7964
US

V. Phone/Fax

Practice location:
  • Phone: 928-929-2142
  • Fax:
Mailing address:
  • Phone: 909-659-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHLEEN ARNOLD
Title or Position: OWNER
Credential: CRNA, APRN
Phone: 909-659-5025