Healthcare Provider Details

I. General information

NPI: 1538635263
Provider Name (Legal Business Name): KATHI ONEAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2018
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 GRANT LINE RD STE 2
NEW ALBANY IN
47150-2492
US

IV. Provider business mailing address

4003 KRESGE WAY STE 300
LOUISVILLE KY
40207-4652
US

V. Phone/Fax

Practice location:
  • Phone: 812-914-7038
  • Fax: 812-924-7661
Mailing address:
  • Phone: 502-897-5139
  • Fax: 502-896-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002571A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: