Provider Demographics
NPI:1518481738
Name:O'BRYAN, KATHARINE ELIZABETH (CAA)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ELIZABETH
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:ELIZABETH
Other - Last Name:HAZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAA
Mailing Address - Street 1:PO BOX 844075
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4075
Mailing Address - Country:US
Mailing Address - Phone:407-667-0505
Mailing Address - Fax:407-667-0509
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:812-944-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-30
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN75000022A367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant