Provider Demographics
NPI:1306917273
Name:OGDEN, KATERINA (PA)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:OGDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATERINA
Other - Middle Name:
Other - Last Name:MATHIOUDAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16500 INDIAN CREEK PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1429
Mailing Address - Country:US
Mailing Address - Phone:913-393-5335
Mailing Address - Fax:913-782-5012
Practice Address - Street 1:15435 W 134TH PLACE
Practice Address - Street 2:SUITE 101
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:913-780-0030
Practice Address - Fax:913-782-2924
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10021590JMedicaid
Q51713Medicare UPIN
KS10021590JMedicaid