Provider Demographics
NPI:1710990924
Name:ECKERT, KATHRYN LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNN
Last Name:ECKERT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:780 KUENZLI ST STE 202
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0837
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:STE 909
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3900
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV75452080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016664Medicaid
NV002016570Medicaid
11040199OtherCAQH