Healthcare Provider Details

I. General information

NPI: 1205061280
Provider Name (Legal Business Name): KATHY R MARQUIS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W COLUMBIA ST
EVANSVILLE IN
47710-1656
US

IV. Provider business mailing address

415 W COLUMBIA ST
EVANSVILLE IN
47710-1656
US

V. Phone/Fax

Practice location:
  • Phone: 812-464-9133
  • Fax: 812-464-0559
Mailing address:
  • Phone: 812-464-9133
  • Fax: 812-464-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberAPPLIED
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: