Provider Demographics
NPI:1386835106
Name:KELLEY, KATHERINE CHEMODUROW (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CHEMODUROW
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:CHEMODUROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2700 N CENTRAL AVE STE 1050
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1217
Mailing Address - Country:US
Mailing Address - Phone:602-376-3353
Mailing Address - Fax:
Practice Address - Street 1:1465 W CHANDLER BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6237
Practice Address - Country:US
Practice Address - Phone:480-786-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ439262084P0800X
SC301012084P0800X
CAA1160712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry