Provider Demographics
NPI:1700928272
Name:NICHOLAS, KATHERINE BARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:BARRETT
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:BARRETT
Other - Last Name:MCNIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3300 PROVIDENCE DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4690
Mailing Address - Country:US
Mailing Address - Phone:907-279-0555
Mailing Address - Fax:
Practice Address - Street 1:3300 PROVIDENCE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4690
Practice Address - Country:US
Practice Address - Phone:907-279-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237670208D00000X
PAMD441734208D00000X
AK7782207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice