Provider Demographics
NPI:1740420579
Name:ENSIGN, KATHERINE HARPER (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HARPER
Last Name:ENSIGN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7273 14TH AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-3566
Mailing Address - Country:US
Mailing Address - Phone:916-734-6909
Mailing Address - Fax:
Practice Address - Street 1:7273 14TH AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-3566
Practice Address - Country:US
Practice Address - Phone:916-734-6909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant