Provider Demographics
NPI:1952473696
Name:PRATCHER, KATRINA C (NP)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:C
Last Name:PRATCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:C
Other - Last Name:PRATCHER-OLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:777 E TAHQUITZ CANYON WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6797
Mailing Address - Country:US
Mailing Address - Phone:626-688-6574
Mailing Address - Fax:
Practice Address - Street 1:777 E TAHQUITZ CANYON WAY STE 200
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6797
Practice Address - Country:US
Practice Address - Phone:626-688-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16547363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP3954OtherAZ LICENSE
TNAPN0000015444OtherTN LICENSE