Provider Demographics
NPI:1518223361
Name:MEYERS, KATHERINE I (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:I
Last Name:MEYERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-2112
Mailing Address - Country:US
Mailing Address - Phone:319-462-3571
Mailing Address - Fax:319-462-6043
Practice Address - Street 1:1791 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-2112
Practice Address - Country:US
Practice Address - Phone:319-462-3571
Practice Address - Fax:319-462-6043
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO04717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1518223361Medicaid
IAP01501709OtherRR MEDICARE PTAN
IA719260777Medicare PIN