Provider Demographics
NPI:1437793056
Name:BERNARD, KATRINA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:ANN
Other - Last Name:OVERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1310 NW 74TH PL
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-8410
Mailing Address - Country:US
Mailing Address - Phone:802-881-7520
Mailing Address - Fax:
Practice Address - Street 1:15435 W 134TH PL
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6135
Practice Address - Country:US
Practice Address - Phone:802-881-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02365363A00000X
VT055.0031443363A00000X
NH1539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant