Healthcare Provider Details

I. General information

NPI: 1518132323
Provider Name (Legal Business Name): KATHY A WARNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 AUSTIN BLUFFS PKWY SUITE 205
COLORADO SPRINGS CO
80918-5701
US

IV. Provider business mailing address

3425 AUSTIN BLUFFS PKWY SUITE 205
COLORADO SPRINGS CO
80918-5701
US

V. Phone/Fax

Practice location:
  • Phone: 719-592-1582
  • Fax: 719-592-1370
Mailing address:
  • Phone: 719-592-1582
  • Fax: 719-592-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1144
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: