Healthcare Provider Details

I. General information

NPI: 1306917273
Provider Name (Legal Business Name): KATERINA OGDEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATERINA MATHIOUDAKIS

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 W 134TH PLACE SUITE 101
OLATHE KS
66062
US

IV. Provider business mailing address

16500 INDIAN CREEK PKWY SUITE 101
OLATHE KS
66062-1429
US

V. Phone/Fax

Practice location:
  • Phone: 913-780-0030
  • Fax: 913-782-2924
Mailing address:
  • Phone: 913-393-5335
  • Fax: 913-782-5012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1501032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: