COUNTRY CLINIC PC
NPI 1740561562
Nurse Practitioner - Family in Queen Creek, AZ

Q: What is Country Clinic PC's NPI number?

The NPI number for Country Clinic PC is 1740561562. It was assigned to this organization in the NPPES registry on September 7, 2011.

Q: What is Country Clinic PC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Country Clinic PC was last updated on March 14, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 07, 2011

26416 S MANDARIN DR, QUEEN CREEK, AZ 85142(480) 369-0582(480) 279-4274 Get Directions Write a Review

NPPES record last updated: March 14, 2012. Verified against the NPPES registry weekly; last sync: November 08, 2026.

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About Country Clinic Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTRY CLINIC PC (NPI 1740561562) is a healthcare organization registered as a family in Queen Creek, Arizona and active in the NPI registry since September 2011. The organization lists Katherine C Hakeman, President, as its authorized official.

NPPES Registry Identity

NPI1740561562

Entity TypeOrganization

Primary Taxonomy363LF0000X

Legal Business NameCOUNTRY CLINIC PC

Location Address26416 S MANDARIN DRQueen Creek, AZ 85142-9411

Mailing AddressPo Box 9277Chandler Heights, AZ 85127-9277 · (480) 369-0582 · Fax (480) 279-4274

Phone(480) 369-0582

Fax(480) 279-4274

Organization SubpartNo

Authorized OfficialKatherine C HakemanPresident · (480) 369-0582

Enumeration DateSeptember 7, 2011

Last NPPES UpdateMarch 14, 2012

✔ NPI 1740561562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in AZ · AP2088

26416 S MANDARIN DR, Queen Creek, AZ 85142

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Other Identifiers 2

Medicare PINZ148164AZ

Medicaid644363AZ

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Country Clinic PC's NPI number?

The NPI number for Country Clinic PC is 1740561562. It was assigned to this organization in the NPPES registry on September 7, 2011.

Where is Country Clinic PC located?

Country Clinic PC is located at 26416 S Mandarin Dr, Queen Creek, AZ 85142. The listed phone number is (480) 369-0582.

What is Country Clinic PC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Country Clinic PC was last updated on March 14, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.