Provider Demographics
NPI:1154944411
Name:REGALADO PASTOR, KATTY GABRIELA (PA-C)
Entity type:Individual
Prefix:
First Name:KATTY
Middle Name:GABRIELA
Last Name:REGALADO PASTOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8444 W. 21ST. ST NORTH
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-274-9850
Mailing Address - Fax:316-779-2221
Practice Address - Street 1:8444 W. 21ST. ST NORTH
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-274-9850
Practice Address - Fax:316-779-2221
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1502437363A00000X
KS15-02437363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty