Provider Demographics
NPI:1639442262
Name:LUTHY, KATIE LYNNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LYNNE
Last Name:LUTHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNNE
Other - Last Name:MESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:516 WEST 14TH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1216
Mailing Address - Country:US
Mailing Address - Phone:308-995-4431
Mailing Address - Fax:308-995-3397
Practice Address - Street 1:516 WEST 14TH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1216
Practice Address - Country:US
Practice Address - Phone:308-995-4431
Practice Address - Fax:308-995-3397
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1103222363A00000X
NE1638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant