Provider Demographics
NPI:1386896520
Name:KINNEY, KATHERINE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:KINNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:CASSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:SUITE 332
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-343-8780
Mailing Address - Fax:402-343-8787
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:SUITE 332
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-343-8780
Practice Address - Fax:402-343-8787
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
IA002042363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE98798002Medicare PIN