Healthcare Provider Details

I. General information

NPI: 1336844059
Provider Name (Legal Business Name): KATHERINE HERSOM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 W THUNDERBIRD BLVD
SUN CITY AZ
85351-3004
US

IV. Provider business mailing address

400 N 32ND ST
PHOENIX AZ
85008-6205
US

V. Phone/Fax

Practice location:
  • Phone: 623-832-4728
  • Fax:
Mailing address:
  • Phone: 602-839-3927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number012602
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number012602
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: