Provider Demographics
NPI:1316062383
Name:BRACE, KATHY A (CPM CERTIFIED PROFES)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:A
Last Name:BRACE
Suffix:
Gender:F
Credentials:CPM CERTIFIED PROFES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207
Mailing Address - Country:US
Mailing Address - Phone:316-682-0903
Mailing Address - Fax:316-440-3869
Practice Address - Street 1:10002 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207
Practice Address - Country:US
Practice Address - Phone:316-682-0903
Practice Address - Fax:316-440-3869
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS97020012367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife