Healthcare Provider Details

I. General information

NPI: 1508858754
Provider Name (Legal Business Name): KENNETH B CATON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ROSE LN
WICKENBURG AZ
85390-1447
US

IV. Provider business mailing address

520 ROSE LN
WICKENBURG AZ
85390-1447
US

V. Phone/Fax

Practice location:
  • Phone: 286-841-8339
  • Fax: 623-523-6581
Mailing address:
  • Phone: 928-684-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2897
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2897
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: