Provider Demographics
NPI:1053502955
Name:KATTER, RENEE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:KATTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:444 HOSPITAL WAY
Mailing Address - Street 2:STE 477
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2744
Mailing Address - Country:US
Mailing Address - Phone:208-237-3612
Mailing Address - Fax:208-237-5192
Practice Address - Street 1:4460 KINGS WAY STE 3
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-1900
Practice Address - Country:US
Practice Address - Phone:208-237-3612
Practice Address - Fax:208-237-5192
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2018-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant