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Individual
KATHRYN REBECCA HANNON KING
Active
Individual
KATHRYN REBECCA HANNON KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003873A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300070169
—
IN
01
—
959090176
MEDICARE PTAN
IN
Enumeration date
06/12/2022
Last updated
10/09/2023
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