COUNTRY CLINIC PC (NPI# 1740561562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740561562 |
| Entity Type | Organization |
| Organization Name | COUNTRY CLINIC PC |
| Practice Address |
26416 S Mandarin Dr Queen Creek AZ 85142-9411 |
| Mailing Address |
Po Box 9277 Chandler Heights AZ 85127-9277 |
| Practice Telephone | 4803690582 |
| Practice Fax Number | 4802794274 |
| Mailing Telephone | 4803690582 |
| Mailing Fax Number | 4802794274 |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2012-03-14 |
| Authorized Official Name | KATHERINE C HAKEMAN (PRESIDENT) |
| Authorized Official Telephone | 4803690582 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP2088 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 644363 | 05 |
| Street Address |
26416 S MANDARIN DR |
| City | QUEEN CREEK |
| State | AZ |
| Zip Code | 85142-9411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093346033 | Arizona Dental Professionals, P.C. | Dentist | 20311 S Ellsworth Rd Ste 101, Queen Creek, AZ 85142 | 2020-01-29 |
| 1073158903 | Jonathan Corey Barber | Physical Therapy Assistant | 22424 South Ellsworth Loop Road, #464, Queen Creek, AZ 85142 | 2019-11-14 |
| 1689142333 | Erin Sohr | Occupational Therapy Assistant | 4594 W Federal Way, San Tan Valley, AZ 85142 | 2018-11-10 |
| 1083180723 | Katelyn Hannabach | Physician Assistant | 21323 S Ellsworth Loop Rd Ste 101, Queen Creek, AZ 85142 | 2018-10-20 |
| 1043701899 | Brittany Leigh Amor | Dentist | 18550 E Rittenhouse Rd Ste 103, Queen Creek, AZ 85142 | 2018-05-28 |
| 1861925604 | Shani Thompson | Student in an Organized Health Care Education/Training Program | 22437 S 209th Way, Queen Creek, AZ 85142 | 2017-04-08 |
| 1689115164 | 360 Physical Therapy LLC | Physical Therapist | 21576 S Ellsworth Loop Rd, 150, Queen Creek, AZ 85142 | 2017-03-16 |
| 1891233714 | Candee J. Eisenhart | Nurse Practitioner | 21321 E Ocotillo Rd Ste 102, Queen Creek, AZ 85142 | 2017-02-11 |
| 1790231546 | Carrie Church | Nurse Practitioner | 20185 E Ocotillo Rd Ste 104, Queen Creek, AZ 85142 | 2016-08-31 |
| 1669836649 | Horizon Health and Wellness, Inc. | Community/Behavioral Health | 22713 S. Ellsworth Road, Building A, Queen Creek, AZ 85142 | 2016-04-06 |
| Find all providers in zip 85142 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245845692 | Ramon Nava Jr. | Nurse Practitioner | 162 W Evergreen Pear Ave, Queen Creek, AZ 85140-7911 | 2020-09-12 |
| 1083265516 | Yva Jean-marc | Nurse Practitioner | 22707 S Ellsworth Rd Ste H101, Queen Creek, AZ 85142-7568 | 2019-09-25 |
| 1104472554 | Tracy Holman-speights | Nurse Practitioner | 22652 E Avenida Del Valle, Queen Creek, AZ 85142-9045 | 2019-08-12 |
| 1235691494 | Kimball Jones Carpenter | Nurse Practitioner | 19002 E Kingbird Dr, Queen Creek, AZ 85142-6865 | 2019-04-04 |
| 1487166484 | Marianne Powell | Nurse Practitioner | 21384 E Mewes Rd, Queen Creek, AZ 85142-7975 | 2017-10-30 |
| 1891233714 | Candee J. Eisenhart | Nurse Practitioner | 21321 E Ocotillo Rd Ste 102, Queen Creek, AZ 85142 | 2017-02-11 |
| 1790231546 | Carrie Church | Nurse Practitioner | 20185 E Ocotillo Rd Ste 104, Queen Creek, AZ 85142 | 2016-08-31 |
| 1215380969 | William Bautista Amistad Jr. | Nurse Practitioner | 19244 E Camacho Rd, Queen Creek, AZ 85142-6077 | 2016-07-18 |
| 1982776563 | Sharon Toth | Nurse Practitioner | 31258 N Trail Dust Dr, Queen Creek, AZ 85143-4139 | 2006-11-15 |
| 1316939630 | David John Rope | Nurse Practitioner | 20713 E Ocotillo Rd, Queen Creek, AZ 85242-6117 | 2005-08-23 |
| Find all providers in QUEEN CREEK | ||||
| City | QUEEN CREEK |
| Zip Code | 85142 |
Please comment or provide details below to improve the information on COUNTRY CLINIC PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.