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General NPI Number Information
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NPI Number | 1770212367
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Entity Type | Individual
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Provider Name | KATHERINE TATE PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 1 WYOMING ST
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City | DAYTON
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State | OH
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Zip | 45409-2722
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Country | US
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Telephone | 937-208-3876
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Fax |
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Provider Business Mailing Address
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Address Line | 85 STONE RIDGE LN
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City | MIDDLETOWN
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State | OH
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Zip | 45044-3247
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Country | US
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Telephone | 919-868-1631
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.007621RX
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License Number State | OH
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