Healthcare Provider Details

I. General information

NPI: 1508023797
Provider Name (Legal Business Name): KATHRYN L FICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 491 NORTH
SHIPROCK NM
87420
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-6001
  • Fax: 505-368-7011
Mailing address:
  • Phone: 505-368-6001
  • Fax: 505-368-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number47068
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: