Healthcare Provider Details

I. General information

NPI: 1477562197
Provider Name (Legal Business Name): KATHERINE RAPP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE E MCCORMICK PA-C

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/14/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CRESCENT PL
GAHANNA OH
43230-3086
US

IV. Provider business mailing address

340 POLARIS PKWY
WESTERVILLE OH
43082-7971
US

V. Phone/Fax

Practice location:
  • Phone: 614-545-7900
  • Fax: 614-545-7901
Mailing address:
  • Phone: 614-839-2300
  • Fax: 614-839-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.002434RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: