Provider Demographics
NPI:1255797528
Name:KATONA, DOMONIQUE (PA-C)
Entity type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:
Last Name:KATONA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-706-8357
Mailing Address - Fax:615-523-1910
Practice Address - Street 1:4015 S BUFFALO DR STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7455
Practice Address - Country:US
Practice Address - Phone:725-293-4602
Practice Address - Fax:725-293-5351
Is Sole Proprietor?:No
Enumeration Date:2016-01-02
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1693363A00000X
MAPA6844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant