Provider Demographics
NPI:1841302296
Name:BANGERTER, KATHRYN J (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:J
Last Name:BANGERTER
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:TRIBUNE
Mailing Address - State:KS
Mailing Address - Zip Code:67879-0640
Mailing Address - Country:US
Mailing Address - Phone:620-376-4251
Mailing Address - Fax:620-376-2772
Practice Address - Street 1:321 E HARPER
Practice Address - Street 2:
Practice Address - City:TRIBUNE
Practice Address - State:KS
Practice Address - Zip Code:67879-0640
Practice Address - Country:US
Practice Address - Phone:620-376-4251
Practice Address - Fax:620-376-2772
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSF0596067363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100254530GMedicaid
KS100254530GMedicaid