Provider Demographics
NPI:1346976446
Name:PARK, KATHERINE (CAA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:CAA
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Mailing Address - Street 1:1788 N PIERCE ST APT 2111
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2547
Mailing Address - Country:US
Mailing Address - Phone:201-407-5700
Mailing Address - Fax:
Practice Address - Street 1:900 23RD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2342
Practice Address - Country:US
Practice Address - Phone:202-715-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant