Individual
CATHERINE GRACE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8600
Mailing address
PO BOX 3981, FORT DEFIANCE, AZ 86504-3981
(406) 539-0521
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
39646
MT
363LF0000X
Family Nurse Practitioner
Primary
NUR-APRN-LIC-100842
MT
Other
Enumeration date
06/16/2014
Last updated
11/22/2019
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