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General NPI Number Information
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NPI Number | 1205562394
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Entity Type | Individual
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Provider Name | KAITLIN M HART PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 15525 N 83RD AVE STE 104
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City | PEORIA
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State | AZ
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Zip | 85382-5820
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Country | US
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Telephone | 480-964-2273
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Fax | 623-505-3772
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Provider Business Mailing Address
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Address Line | 18444 N 25TH AVE STE 310
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City | PHOENIX
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State | AZ
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Zip | 85023-1266
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Country | US
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Telephone | 866-974-2673
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Fax | 866-939-2673
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9257
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9257
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License Number State | AZ
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