MEDICARE: MRS. KATHRYN LEAH WILMOT RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	243651	AZ

General Provider Information

NPI Number	:	1154280832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN LEAH WILMOT RN

Provider Business Mailing Address
First Line	:	7449 N 43RD LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2238
Country	:	US
Telephone Number	:	602-618-2265
Fax Number	:	602-618-2265

Provider Business Practice Location Address
First Line	:	7449 N 43RD LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2238
Country	:	US
Telephone Number	:	602-618-2265
Fax Number	:	602-618-2265

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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