Provider Demographics
NPI:1821020538
Name:RAU, KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:RAU
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:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:WISHEK
Mailing Address - State:ND
Mailing Address - Zip Code:58495-0647
Mailing Address - Country:US
Mailing Address - Phone:701-452-2364
Mailing Address - Fax:701-452-4276
Practice Address - Street 1:1015 4TH AVE S
Practice Address - Street 2:
Practice Address - City:WISHEK
Practice Address - State:ND
Practice Address - Zip Code:58495-7527
Practice Address - Country:US
Practice Address - Phone:701-452-2364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND970002186OtherRR MEDICARE
ND12911OtherBSND @ GACKLE
ND5085Medicaid
ND5166Medicaid
ND1008357OtherPREFERRED ONE
ND12912OtherBSND @ WISHEK
ND13969Medicaid
ND01-18080OtherMEDICA @ WISHEK
ND01-18081OtherMEDICA @ KULM
ND01-18083OtherMEDICA @ NAPOLEON
ND12913OtherBSND @ NAPOLEON
ND5063Medicaid
ND975382OtherAMERICA'S PPO
ND5028Medicaid
ND353408Medicare Oscar/Certification
ND1008357OtherPREFERRED ONE
ND12912OtherBSND @ WISHEK
ND5028Medicaid
NDN12911Medicare Oscar/Certification
ND353443Medicare Oscar/Certification