Provider Demographics
NPI:1700035920
Name:CARROLL, KATHERINE B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:B
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:NEUROSURGERY ML 2016
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4726
Mailing Address - Fax:513-636-2808
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:NEUROSURGERY ML 2016
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4726
Practice Address - Fax:513-636-2808
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003969363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical