Provider Demographics
NPI:1710055082
Name:DUKE, KATHERINE ROSE (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSE
Last Name:DUKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 W 109TH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1313
Mailing Address - Country:US
Mailing Address - Phone:913-469-1115
Mailing Address - Fax:913-948-9164
Practice Address - Street 1:4601 W 109TH ST STE 116
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1313
Practice Address - Country:US
Practice Address - Phone:913-469-1115
Practice Address - Fax:913-948-9164
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-46132-032363LF0000X
MO2006001233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSJ41F755Medicare PIN