1033460621 NPI number — MRS. KATHERINE JO CALVERT PA-C

Table of content: MRS. KATHERINE JO CALVERT PA-C (NPI 1033460621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033460621 NPI number — MRS. KATHERINE JO CALVERT PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALVERT
Provider First Name:
KATHERINE
Provider Middle Name:
JO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEAL
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033460621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42101-1759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-781-5111
Provider Business Mailing Address Fax Number:
270-850-3120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 PARK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-745-1626
Provider Business Practice Location Address Fax Number:
270-850-3120
Provider Enumeration Date:
09/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA-1766 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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