Provider Demographics
NPI:1386601755
Name:ONEAL, KATHRYN JOAN (ARNP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JOAN
Last Name:ONEAL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1295 W FAIRFIELD DR
Mailing Address - Street 2:ATTN: SUSIE PITMAN
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1107
Mailing Address - Country:US
Mailing Address - Phone:850-595-6417
Mailing Address - Fax:850-595-6693
Practice Address - Street 1:1295 W FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1107
Practice Address - Country:US
Practice Address - Phone:850-595-6417
Practice Address - Fax:850-595-6693
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2238512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0301259000Medicaid