Provider Demographics
NPI:1013974575
Name:TJADEN, KATHERINE M (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:TJADEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:RHOADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3014
Mailing Address - Street 2:1215 DUFF AVE MCFARLAND CLINIC PC
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4501
Mailing Address - Fax:515-239-4446
Practice Address - Street 1:3800 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-3402
Practice Address - Country:US
Practice Address - Phone:515-956-4100
Practice Address - Fax:515-956-4108
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI12876OtherMEDICARE B
IA0638536Medicaid
IA0152082OtherMEDICAID HOSPITAL
IA163853Medicare Oscar/Certification
Q22250Medicare UPIN
IAI12876OtherMEDICARE B
IA0152082OtherMEDICAID HOSPITAL