Provider Demographics
NPI:1467426122
Name:PLEUNE, KATHRYN JOY (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JOY
Last Name:PLEUNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JOY
Other - Last Name:MIEDEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1000 EAST PARIS AVE SE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-957-9237
Mailing Address - Fax:616-957-1013
Practice Address - Street 1:1000 EAST PARIS AVE SE
Practice Address - Street 2:SUITE 260
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-957-9237
Practice Address - Fax:616-957-1013
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P58188Medicare UPIN
N48650009Medicare PIN