Provider Demographics
NPI:1215373402
Name:ANDO, KATHRYN AKEMI (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:AKEMI
Last Name:ANDO
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 1:102 E LAKE MEAD PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5575
Mailing Address - Country:US
Mailing Address - Phone:702-616-4600
Mailing Address - Fax:
Practice Address - Street 1:102 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5575
Practice Address - Country:US
Practice Address - Phone:026-164-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215373402Medicaid
AZ1215373402Medicaid
UT3009775Medicaid