Individual provider Active NPI

Kathleen Mahoney, RN MSN CPNP

  • Pediatric Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1255380770
Registry record updated Jun 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
226450 Issued in AZ
Practice address
6601 W Thomas Rd
Phoenix, AZ 85033-5700
Phone
(602) 243-7277
NPI assigned
May 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 226450 AZ Primary
Pediatric Nurse Practitioner 363LP0200X 2002018343 MO

Addresses

Primary practice location

6601 W Thomas Rd
Phoenix, AZ 85033-5700

Mailing address

3003 N Central Ave Ste 1600
Phoenix, AZ 85012-2908
Phone (602) 323-3344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190815001319 AZ Practitioner - Nurse Practitioner 0345318705 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
2002018343MOMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Park Health Center CurrentSince Jul 8, 2019 Accepting new patients
Mountain Park Health Center CurrentSince Jul 8, 2019 Accepting new patients
Mountain Park Health Center - Dental Past Accepting new patients
Mountain Park Health Center Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

4222 N 51st Ave
Phoenix, AZ 85031

635 E Baseline Rd
Phoenix, AZ 85042

6601 W Thomas Rd
Phoenix, AZ 85033

5517 N 17th Ave
Phoenix, AZ 85015
Phone (602) 242-7717

3003 N Central Ave
Ste 1600
Phoenix, AZ 85012
Phone (602) 323-3492

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561593600000",
    "number": "1255380770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 N CENTRAL AVE STE 1600",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122908",
            "telephone_number": "602-323-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 W THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850335700",
            "telephone_number": "602-243-7277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "KATHLEEN",
        "credential": "RN MSN CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2019-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "226450",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2002018343",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.