Provider Demographics
NPI:1467883769
Name:INGLE, KATHERINE RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RENEE
Last Name:INGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:RENEE
Other - Last Name:HEYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8017
Mailing Address - Country:US
Mailing Address - Phone:770-292-3490
Mailing Address - Fax:770-721-5615
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8017
Practice Address - Country:US
Practice Address - Phone:770-292-3490
Practice Address - Fax:770-721-5615
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08835171000000X, 363A00000X
363A00000X
GA10173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider