Provider Demographics
NPI:1659884385
Name:ZIMMERMAN, KATHRYN OLIVIA (PA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:OLIVIA
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:P O BOX 122165
Mailing Address - Street 2:DEPT 2165
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2165
Mailing Address - Country:US
Mailing Address - Phone:337-494-2948
Mailing Address - Fax:337-494-2928
Practice Address - Street 1:1717 OAK PARK BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8990
Practice Address - Country:US
Practice Address - Phone:337-494-4900
Practice Address - Fax:337-494-4936
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA307370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant