Healthcare Provider Details

I. General information

NPI: 1982938593
Provider Name (Legal Business Name): KATHLEEN M. THATCHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N. EWING STREET FAIRFIELD EMERGENCY PHYSICIANS
LANCASTER OH
43130
US

IV. Provider business mailing address

14279 STATE ROUTE 93 S
LOGAN OH
43138-9786
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-8101
  • Fax:
Mailing address:
  • Phone: 740-380-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.000713
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: