Provider Demographics
NPI:1275569303
Name:CHARLTON, KATHRYN L (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 FOUR STATES DR STE 1
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:KS
Mailing Address - Zip Code:66739-4325
Mailing Address - Country:US
Mailing Address - Phone:620-834-4414
Mailing Address - Fax:
Practice Address - Street 1:444 FOUR STATES DR STE 1
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4325
Practice Address - Country:US
Practice Address - Phone:620-783-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80753-042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427385109Medicaid
OK200077810AMedicaid
KS200371350AMedicaid
431560263OtherTRICARE WEST
P00689771OtherRR MEDICARE
MO427385109Medicaid
Q67295Medicare UPIN