=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376926097
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE ELIZABETH WARD PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2015
-----------------------------------------------------
Last Update Date | 01/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1514 JEFFERSON HWY
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70121-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-624-7637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 JAN ST
-----------------------------------------------------
City | EUNICE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70535-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-523-7885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | PA.200844
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------