Provider Demographics
NPI:1770801367
Name:SMALL, KATHERINE (CRNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000 WATERDAM PLAZA DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5412
Mailing Address - Country:US
Mailing Address - Phone:724-942-4372
Mailing Address - Fax:
Practice Address - Street 1:455 VALLEY BROOK RD STE 300
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3367
Practice Address - Country:US
Practice Address - Phone:724-941-5588
Practice Address - Fax:724-941-1458
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP010813363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA325256Medicare PIN