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General NPI Number Information
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NPI Number | 1336329523
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Entity Type | Individual
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Provider Name | KATHRYN ANN WERNER PA
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Gender | Female
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 3527 S FEDERAL WAY SUITE 103-424
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City | BOISE
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State | ID
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Zip | 83705-5204
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Country | US
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Telephone | 208-391-7280
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Fax | 534-202-4595
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Provider Business Mailing Address
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Address Line | 2008 WYNFIELD DR.
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City | PRATTVILLE
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State | AL
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Zip | 36067-7157
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Country | US
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Telephone | 208-391-7280
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Fax | 534-202-4595
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number | PA1284
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number | PA1373
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1373
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1284
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License Number State | ID
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