Provider Demographics
NPI:1326291832
Name:KATHIE A, MATES, CRNP, LLC
Entity Type:Organization
Organization Name:KATHIE A, MATES, CRNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MATES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:412-610-1711
Mailing Address - Street 1:810 JAMISON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5438
Mailing Address - Country:US
Mailing Address - Phone:412-610-1711
Mailing Address - Fax:724-832-8344
Practice Address - Street 1:810 JAMISON AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5438
Practice Address - Country:US
Practice Address - Phone:412-610-1711
Practice Address - Fax:724-832-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPOO7875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ59430 PAOtherUPIN
PA1015566820001PAMedicaid
PA1538231204OtherNPI
PA096818QPF PAMedicare PIN