Provider Demographics
NPI:1013643154
Name:CRAMER, KATIE MARIE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:MARIE
Last Name:CRAMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15804 W MCCORMICK AVE
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-5213
Mailing Address - Country:US
Mailing Address - Phone:316-768-0059
Mailing Address - Fax:
Practice Address - Street 1:15804 W MCCORMICK AVE
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-5213
Practice Address - Country:US
Practice Address - Phone:167-680-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-30
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant