Provider Demographics
NPI:1225454622
Name:BADGER, KATHARINE (PA)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:BADGER
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1643 NW 136 AVE
Mailing Address - Street 2:STE 100 MSC 11607-0001
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2857
Mailing Address - Country:US
Mailing Address - Phone:954-584-1000
Mailing Address - Fax:865-560-7110
Practice Address - Street 1:354 BIRNIE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1108
Practice Address - Country:US
Practice Address - Phone:413-733-3470
Practice Address - Fax:413-732-4216
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2024-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA4948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant