Provider Demographics
NPI:1720345242
Name:URBAN, KATIE L (PA-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:URBAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:L
Other - Last Name:KRESGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:PRESHO
Mailing Address - State:SD
Mailing Address - Zip Code:57568-0422
Mailing Address - Country:US
Mailing Address - Phone:605-895-2589
Mailing Address - Fax:605-895-2325
Practice Address - Street 1:116 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PRESHO
Practice Address - State:SD
Practice Address - Zip Code:57568-0422
Practice Address - Country:US
Practice Address - Phone:605-895-2589
Practice Address - Fax:605-895-2325
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant