Provider Demographics
NPI:1851398796
Name:PAINTER, KATHRYN L (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:PAINTER
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3911 AVENUE B
Mailing Address - Street 2:STE 3100
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-635-3033
Mailing Address - Fax:308-635-3010
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:STE 3100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-635-3033
Practice Address - Fax:308-635-3010
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE21530207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00277OtherBCBS
WY117496700Medicaid
H60343Medicare UPIN
WY117496700Medicaid