Provider Demographics
NPI:1558404608
Name:WADE, KATRINA (PA-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:WADE
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Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 MEDICAL PARK
Mailing Address - Street 2:TOWER 3 SUITE 232
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6391
Mailing Address - Country:US
Mailing Address - Phone:304-243-8300
Mailing Address - Fax:304-243-8306
Practice Address - Street 1:30 MEDICAL PARK
Practice Address - Street 2:TOWER 3 SUITE 232
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6391
Practice Address - Country:US
Practice Address - Phone:304-243-8300
Practice Address - Fax:304-243-8306
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV01262363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical