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NPI Code Detail

MEDICARE: KATHY GRIESEMER PA-C

MEDICARE: KATHY GRIESEMER PA-C
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
1363A00000XPhysician Assistant2045AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639165822
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY GRIESEMER PA-C
Provider Business Mailing Address
First Line : 101 COLE AVENUE
Second Line :
City : BISBEE
State : AZ
Zip : 85603
Country : US
Telephone Number : 520-366-0300
Fax Number : 520-432-2098
Provider Business Practice Location Address
First Line : 101 COLE AVE
Second Line :
City : BISBEE
State : AZ
Zip : 85603-1327
Country : US
Telephone Number : 520-432-6481
Fax Number : 520-432-2098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 08/12/2022

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Directions to “ KATHY GRIESEMER PA-C” Practice Location

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