Provider Demographics
NPI:1215930730
Name:O'CONNOR, KARY L (CNS/CRNFA)
Entity type:Individual
Prefix:
First Name:KARY
Middle Name:L
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:CNS/CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 E YUCCA ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-1204
Mailing Address - Country:US
Mailing Address - Phone:520-836-3229
Mailing Address - Fax:520-836-4053
Practice Address - Street 1:1114 E YUCCA ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-1204
Practice Address - Country:US
Practice Address - Phone:520-836-3229
Practice Address - Fax:520-836-4053
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN063848364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0162090OtherBLUE CROSS PROVIDER #
AZ181470Medicaid
AZ181470Medicaid