Provider Demographics
NPI:1740672583
Name:LONSBERRY, KATHRYN (MPAS)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:LONSBERRY
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 LOOP RD STE C
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-3341
Mailing Address - Country:US
Mailing Address - Phone:318-435-6363
Mailing Address - Fax:
Practice Address - Street 1:6767 29TH ST FL 3
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5474
Practice Address - Country:US
Practice Address - Phone:970-652-2801
Practice Address - Fax:970-652-2827
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007545363A00000X
LAPA.200796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA.0007545OtherSTATE LICENSE
LAPA.200796OtherLICENSE