Provider Demographics
NPI:1275886772
Name:RADKOWSKI, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:RADKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21873
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-1873
Mailing Address - Country:US
Mailing Address - Phone:661-323-1200
Mailing Address - Fax:661-323-1204
Practice Address - Street 1:9802 STOCKDALE HWY
Practice Address - Street 2:102
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3652
Practice Address - Country:US
Practice Address - Phone:661-323-1200
Practice Address - Fax:661-323-1204
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant