Provider Demographics
NPI:1306136049
Name:MEDINA, KATHERINE BETH (SOCIAL SCIENCE, BS)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BETH
Last Name:MEDINA
Suffix:
Gender:F
Credentials:SOCIAL SCIENCE, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 HUNTERS WAY
Mailing Address - Street 2:APT A
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2380
Mailing Address - Country:US
Mailing Address - Phone:307-214-4688
Mailing Address - Fax:
Practice Address - Street 1:331 HUNTERS WAY
Practice Address - Street 2:APT A
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2380
Practice Address - Country:US
Practice Address - Phone:307-214-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator