=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720054992
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN B MCLEOD FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2006
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5210 E FARNESS DR
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-525-9433
-----------------------------------------------------
Fax | 520-849-7441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5210 E FARNESS DR
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-525-9433
-----------------------------------------------------
Fax | 520-849-7441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP1315
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------