Provider Demographics
NPI:1033460621
Name:CALVERT, KATHERINE JO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JO
Last Name:CALVERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JO
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:270-850-3120
Practice Address - Street 1:250 PARK STREET
Practice Address - Street 2:
Practice Address - City:BOWLING
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-745-1626
Practice Address - Fax:270-850-3120
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA-1766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant