Provider Demographics
NPI:1821574807
Name:TUTTLE, KATHERINE GRACE (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:GRACE
Last Name:TUTTLE
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 1:90521 SUGAR FACTORY RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-7403
Mailing Address - Country:US
Mailing Address - Phone:308-641-7980
Mailing Address - Fax:
Practice Address - Street 1:COMMUNITY ACTION PARTNERSHIP OF WESTERN NEBRASKA
Practice Address - Street 2:3350 10TH STREET
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341
Practice Address - Country:US
Practice Address - Phone:308-632-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily