Healthcare Provider Details

I. General information

NPI: 1952302226
Provider Name (Legal Business Name): KATHLEEN A KOTTAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 POLK ST
GREAT BEND KS
67530-3618
US

IV. Provider business mailing address

1309 POLK ST
GREAT BEND KS
67530-3618
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-5341
  • Fax: 620-792-3702
Mailing address:
  • Phone: 620-792-5341
  • Fax: 620-792-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44789
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: