Provider Demographics
NPI:1386248011
Name:DAVIDSON, KATHRYN ANNE-PRIOR (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE-PRIOR
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 W LAS POSITAS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4007
Mailing Address - Country:US
Mailing Address - Phone:925-272-2860
Mailing Address - Fax:
Practice Address - Street 1:5725 W LAS POSITAS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4007
Practice Address - Country:US
Practice Address - Phone:925-272-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59725363A00000X
CA59725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty