Provider Demographics
NPI:1295796373
Name:KLAS, KATHLEEN E (PNP, RNFA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:KLAS
Suffix:
Gender:F
Credentials:PNP, RNFA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:E
Other - Last Name:ZERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:1919 E THOMAS RD
Mailing Address - Street 2:BUILDING 2108, SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-512-8029
Mailing Address - Fax:602-512-8161
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:AMBULATORY BUILDING
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-0975
Practice Address - Fax:602-933-0445
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN103690/AP1529363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P86996Medicare UPIN