Provider Demographics
NPI:1336329523
Name:WERNER, KATHRYN ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:WERNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2008 WYNFIELD DR.
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-7157
Mailing Address - Country:US
Mailing Address - Phone:208-391-7280
Mailing Address - Fax:534-202-4595
Practice Address - Street 1:3527 S FEDERAL WAY
Practice Address - Street 2:SUITE 103-424
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5204
Practice Address - Country:US
Practice Address - Phone:208-391-7280
Practice Address - Fax:534-202-4595
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA12842084B0040X, 363A00000X
ALPA13732084B0040X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPA-1284OtherIDAHO BOARD OF MEDICINE
ALPA.1373OtherALABAMA BOARD OF MEDICAL EXAMINERS