Healthcare Provider Details

I. General information

NPI: 1194292920
Provider Name (Legal Business Name): KATIE BEUTLER RALON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 05/19/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 N SCOTTSDALE RD STE 104
TEMPE AZ
85288-2116
US

IV. Provider business mailing address

914 N SCOTTSDALE RD STE 104
TEMPE AZ
85288-2116
US

V. Phone/Fax

Practice location:
  • Phone: 480-924-8382
  • Fax: 480-966-0566
Mailing address:
  • Phone: 480-924-8382
  • Fax: 480-966-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8838
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: