Provider Demographics
NPI:1881143204
Name:PRICE, KATHRYN ELIZABETH (PA-C, MHA, RDN/LD)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:PRICE
Suffix:
Gender:F
Credentials:PA-C, MHA, RDN/LD
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, MHA, RDN/LD
Mailing Address - Street 1:5750 CEDAR TREE CIR
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-4456
Mailing Address - Country:US
Mailing Address - Phone:580-716-1998
Mailing Address - Fax:
Practice Address - Street 1:2919 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6806
Practice Address - Country:US
Practice Address - Phone:405-282-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2178133V00000X
OK5329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered