Provider Demographics
NPI:1407688690
Name:LOUCHHEIM, KAITLYN ROSE (NP-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROSE
Last Name:LOUCHHEIM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 E EVANS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2823
Mailing Address - Country:US
Mailing Address - Phone:480-271-8761
Mailing Address - Fax:
Practice Address - Street 1:23425 N SCOTTSDALE RD # A103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3469
Practice Address - Country:US
Practice Address - Phone:480-513-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ312932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily