Basic Information
| Provider Information | |||||||||
| NPI: | 1790940211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHODES | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | KAYE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BURKE | ||||||||
| OtherFirstName: | KATHRYN | ||||||||
| OtherMiddleName: | KAYE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 801 N BEDELL AVE | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788404112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307031733 | ||||||||
| FaxNumber: | 8307757230 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 N BEDELL AVE | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788404112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307031733 | ||||||||
| FaxNumber: | 8307757230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2008 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | TEMPORARY | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | TEMPORARY | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | TEMPORARY | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1790940211 | 05 | TX | MEDICAID |