Healthcare Provider Details

I. General information

NPI: 1962829713
Provider Name (Legal Business Name): KATHLEEN POSPISIL BRADY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24112 W JOMAX RD
WITTMANN AZ
85361-5506
US

IV. Provider business mailing address

24112 W JOMAX RD
WITTMANN AZ
85361-5506
US

V. Phone/Fax

Practice location:
  • Phone: 602-833-4096
  • Fax: 602-536-0870
Mailing address:
  • Phone: 602-833-4096
  • Fax: 602-536-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5393
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number32300265
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: