Individual
KATHY L DOMIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
504 NW 10TH AVE, AVA, MO 65608
(417) 683-4831
(417) 683-1602
Mailing address
504 NW 10TH AVE, PO BOX 1359, AVA, MO 65608
(417) 683-4831
(417) 683-1602
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
154500
MO
Other
Enumeration date
09/06/2007
Last updated
03/06/2008
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