Provider Demographics
NPI:1407643760
Name:OSWALT, KATHRYN DETORE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DETORE
Last Name:OSWALT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 PENNY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-8284
Mailing Address - Country:US
Mailing Address - Phone:260-418-9980
Mailing Address - Fax:
Practice Address - Street 1:5920 PENNY BROOK LN
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-8284
Practice Address - Country:US
Practice Address - Phone:260-418-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant