Provider Demographics
NPI:1619189040
Name:DEINES, KATHY A
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:DEINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4669
Mailing Address - Country:US
Mailing Address - Phone:307-742-9413
Mailing Address - Fax:
Practice Address - Street 1:809 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4669
Practice Address - Country:US
Practice Address - Phone:307-742-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management