MEDICARE: KATHY A WARNER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1144	CO

General Provider Information

NPI Number	:	1518132323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY A WARNER PA

Provider Business Mailing Address
First Line	:	3425 AUSTIN BLUFFS PKWY
Second Line	:	SUITE 205
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5701
Country	:	US
Telephone Number	:	719-592-1582
Fax Number	:	719-592-1370

Provider Business Practice Location Address
First Line	:	3425 AUSTIN BLUFFS PKWY
Second Line	:	SUITE 205
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5701
Country	:	US
Telephone Number	:	719-592-1582
Fax Number	:	719-592-1370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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