Provider Demographics
NPI:1942692124
Name:CHAPPELL, KATHERINA TAYLOR (PA-C, MPA)
Entity Type:Individual
Prefix:
First Name:KATHERINA
Middle Name:TAYLOR
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:PA-C, MPA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, MPA
Mailing Address - Street 1:975 RYLAND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1667
Mailing Address - Country:US
Mailing Address - Phone:775-982-5000
Mailing Address - Fax:775-982-5225
Practice Address - Street 1:780 KUENZLI ST
Practice Address - Street 2:STE 202
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-0845
Practice Address - Country:US
Practice Address - Phone:775-982-4590
Practice Address - Fax:775-982-4595
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA1607OtherPA-C LICENSE
NV13543525OtherCAQH