Provider Demographics
NPI:1356432595
Name:MEURER, KATHRYN ANN (PAC)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:MEURER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5806 DOBSON DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9999
Mailing Address - Country:US
Mailing Address - Phone:859-797-4770
Mailing Address - Fax:
Practice Address - Street 1:101 ROBESON
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5520
Practice Address - Country:US
Practice Address - Phone:859-236-9292
Practice Address - Fax:859-236-3713
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA505363A00000X
NC0010-05896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS96495Medicare UPIN
KY0994301Medicare PIN