Provider Demographics
NPI:1689908550
Name:KATONA, KERRI ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ANNE
Last Name:KATONA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:ANNE
Other - Last Name:PREDIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:850 N OTSEGO AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1568
Mailing Address - Country:US
Mailing Address - Phone:989-731-7708
Mailing Address - Fax:989-731-7929
Practice Address - Street 1:3696 S STRAITS HWY
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-5136
Practice Address - Country:US
Practice Address - Phone:231-238-0581
Practice Address - Fax:231-238-0586
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF96004OtherMEDICARE GROUP PTAN