Provider Demographics
NPI:1558839977
Name:GAGNON, KATE ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:ANN
Last Name:GAGNON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:ANN
Other - Last Name:WORTHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:318 MAIN STREET
Mailing Address - Street 2:SUITE 165
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532
Mailing Address - Country:US
Mailing Address - Phone:508-936-1657
Mailing Address - Fax:888-355-3778
Practice Address - Street 1:318 MAIN STREET
Practice Address - Street 2:SUITE 165
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532
Practice Address - Country:US
Practice Address - Phone:508-936-1657
Practice Address - Fax:888-355-3778
Is Sole Proprietor?:No
Enumeration Date:2018-11-03
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7015363A00000X
NHPA7015363A00000X
NH1497363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty