Healthcare Provider Details

I. General information

NPI: 1518481738
Provider Name (Legal Business Name): KATHARINE ELIZABETH O'BRYAN CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHARINE ELIZABETH HAZEL CAA

II. Dates (important events)

Enumeration Date: 07/30/2017
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

PO BOX 844075
DALLAS TX
75284-4075
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-7701
  • Fax:
Mailing address:
  • Phone: 407-667-0505
  • Fax: 407-667-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number75000022A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: