Provider Demographics
NPI:1467785428
Name:MASON, KATHERINE INEZ (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:INEZ
Last Name:MASON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1653
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92502-1653
Mailing Address - Country:US
Mailing Address - Phone:816-616-5746
Mailing Address - Fax:844-233-0782
Practice Address - Street 1:4445 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4135
Practice Address - Country:US
Practice Address - Phone:816-616-5746
Practice Address - Fax:844-233-0782
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23094363LF0000X
CA838603163W00000X
CORN.1636152163W00000X
COAPN.0992145-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
44815011OtherBCBS OF KC
MO1467785428Medicaid
44815011OtherBCBS OF KC