Individual
KATELYN MABEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
550 S HUDSON AVE, AURORA, MO 65605-2362
(417) 678-5176
Mailing address
1401 S FREMONT AVE, SPRINGFIELD, MO 65804-1105
(417) 830-9100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2015002491
MO
Other
Enumeration date
02/02/2015
Last updated
05/10/2016
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