Provider Demographics
NPI:1932135118
Name:YORK, CATHERINE B (APRN-BC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:B
Last Name:YORK
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:BROOKE
Other - Last Name:HADDOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1911 S NATIONAL AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2213
Mailing Address - Country:US
Mailing Address - Phone:417-886-5000
Mailing Address - Fax:417-886-1100
Practice Address - Street 1:1911 S NATIONAL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2213
Practice Address - Country:US
Practice Address - Phone:417-886-5000
Practice Address - Fax:417-886-1100
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018170363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1932135118Medicaid
MO1932135118Medicaid
MO831142599Medicare PIN