Provider Demographics
NPI:1891796496
Name:DESANTIS, KATHRYN RUTH (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:RUTH
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 SW DAVID DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-6429
Mailing Address - Country:US
Mailing Address - Phone:801-272-1246
Mailing Address - Fax:
Practice Address - Street 1:1378 SW DAVID DR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-6429
Practice Address - Country:US
Practice Address - Phone:801-272-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT02758224405363LF0000X
UT02758228900363LF0000X
UT0349373363LF0000X
OR201603205NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily