Provider Demographics
NPI:1467417147
Name:WITHERINGTON, KATHERINE A (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:WITHERINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:G-1, #11
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1384
Practice Address - Country:US
Practice Address - Phone:502-636-8121
Practice Address - Fax:502-636-8128
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000350823OtherANTHEM FOR NCMA
KY048237OtherSIHO FOR NCMA
KY2446867000OtherPAD FOR NCMA
KY64168164Medicaid
KYP00181596OtherRAILROAD MEDICARE
KY000014952TOtherHUMANA FOR NCMA
KY1184338OtherCHA / NCMA
KY4184997OtherCIGNA / NCMA
KY50005563OtherPASSPORT FOR NCMA
KY50005563OtherPASSPORT FOR NCMA
F29347Medicare UPIN