Provider Demographics
NPI:1043242621
Name:EATON, KATHRYN D (APRN-BC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:EATON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:D
Other - Last Name:LUTGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:634 SW MULVANE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606
Mailing Address - Country:US
Mailing Address - Phone:785-295-7979
Mailing Address - Fax:785-295-7996
Practice Address - Street 1:634 SW MULVANE STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606
Practice Address - Country:US
Practice Address - Phone:785-295-7979
Practice Address - Fax:785-295-7996
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44905363L00000X
KS53-44905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS160490LUMedicare ID - Type Unspecified
KSP15196Medicare UPIN