Provider Demographics
NPI:1366606493
Name:SWAN, KATHERINE ARMSTRONG (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ARMSTRONG
Last Name:SWAN
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 1:12667 AMARILLO DR
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-3330
Mailing Address - Country:US
Mailing Address - Phone:757-303-6551
Mailing Address - Fax:
Practice Address - Street 1:12667 AMARILLO DR
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-3330
Practice Address - Country:US
Practice Address - Phone:757-303-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104655363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000259500Medicaid