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General NPI Number Information
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NPI Number | 1114205317
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Entity Type | Individual
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Provider Name | MS. CATRINA YVETTE PRATHER
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Gender | Female
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 410 N MALACATE ST
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City | AJO
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State | AZ
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Zip | 85321-2254
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Country | US
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Telephone | 520-387-5287
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Fax |
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Provider Business Mailing Address
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Address Line | 440 W SOLANA AVE
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City | AJO
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State | AZ
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Zip | 85321-2240
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Country | US
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Telephone | 601-812-7205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP4178
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R880823
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License Number State | MS
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