MISS KATHY RENEE WILLIS NPI 1932476611

NPI Information

NPI: 1932476611
Provider Name: MISS KATHY RENEE WILLIS
Classification: Respite Care - 385HR2055X
Specialization: Respite Care, Mental Illness, Child
Entity Type: Individual
Address: 11026 E SEGURA AVE
MESA, AZ
ZIP 85212
Phone: (480) 235-9107

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NPI Details

MISS Kathy Renee Willis is a respite care and mental illness and child respite care in Mesa, AZ. The provider is a facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers. MISS Kathy Renee Willis NPI is 1932476611. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

11026 E SEGURA AVE
MESA, AZ
ZIP 85212-214
Phone: (480) 235-9107

The enumeration date for this NPI number is 11/22/2011 and was last updated on 8/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	104100000X	Social Worker		3162012	ARIZONA	No
2	385HR2055X	Respite Care	Respite Care, Mental Illness, Child	3162012	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3162012	OTHER	ARIZONA	AZ DEPT OF HEALTH SERVICES

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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