Provider Demographics
NPI:1861559247
Name:GUNTER, KATHY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:GUNTER
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 1:2115 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2109
Mailing Address - Country:US
Mailing Address - Phone:405-262-2640
Mailing Address - Fax:405-295-1334
Practice Address - Street 1:2115 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2109
Practice Address - Country:US
Practice Address - Phone:405-262-2640
Practice Address - Fax:405-295-1334
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR99487Medicare UPIN
OKPA003421Medicare ID - Type Unspecified