Provider Demographics
NPI:1184153611
Name:UPAH, KATHRYN MAE (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MAE
Last Name:UPAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MAE
Other - Last Name:BOCKHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:498 N HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52361
Mailing Address - Country:US
Mailing Address - Phone:515-447-2141
Mailing Address - Fax:
Practice Address - Street 1:498 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361-9695
Practice Address - Country:US
Practice Address - Phone:319-668-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087811363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant