Provider Demographics
NPI:1144855438
Name:BROTHERTON, KATHERINE ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3801 FAIRWAY PARK DR APT 209
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2998
Mailing Address - Country:US
Mailing Address - Phone:614-312-1573
Mailing Address - Fax:
Practice Address - Street 1:3562 RIDGE PARK DR STE D1
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9294
Practice Address - Country:US
Practice Address - Phone:330-664-1670
Practice Address - Fax:330-664-1675
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY024778363A00000X
OH50.006130RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant