Provider Demographics
NPI:1639148414
Name:PUFFENBARGER, KATHLEEN A (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:PUFFENBARGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 SHASTA WAY
Mailing Address - Street 2:SUITE #7
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4455
Mailing Address - Country:US
Mailing Address - Phone:541-882-2118
Mailing Address - Fax:541-882-0617
Practice Address - Street 1:2655 SHASTA WAY
Practice Address - Street 2:SUITE #7
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4455
Practice Address - Country:US
Practice Address - Phone:541-882-2118
Practice Address - Fax:541-882-0617
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000037198N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277731Medicaid
OR050WFBRPAMedicare ID - Type Unspecified
OR277731Medicaid