Provider Demographics
NPI:1518015411
Name:SOTO, KATHERINE HINES (PA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HINES
Last Name:SOTO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:KATHERINE
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:11 DOCTORS PARK DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1024
Practice Address - Country:US
Practice Address - Phone:864-573-3593
Practice Address - Fax:864-515-9789
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0211PAMedicaid
SCP00803534OtherRR MEDICARE
SC0211PAMedicaid
SCAA02103640Medicare PIN