Basic Information
| Provider Information | |||||||||
| NPI: | 1336601210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORMAN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | APRN FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4244 W VERNON AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850091010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153516600 | ||||||||
| FaxNumber: | 6237776004 | ||||||||
| Practice Location | |||||||||
| Address1: | 11202 W JOBLANCA RD | ||||||||
| Address2: | |||||||||
| City: | AVONDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239202720 | ||||||||
| FaxNumber: | 6237776004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2019 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP141021 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.