Healthcare Provider Details

I. General information

NPI: 1851398796
Provider Name (Legal Business Name): KATHRYN L PAINTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 AVENUE B STE 3100
SCOTTSBLUFF NE
69361-4617
US

IV. Provider business mailing address

3911 AVENUE B STE 3100
SCOTTSBLUFF NE
69361-4617
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-3033
  • Fax: 308-635-3010
Mailing address:
  • Phone: 308-635-3033
  • Fax: 308-635-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21530
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number21530
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: