Provider Demographics
NPI:1538180096
Name:GATES, KATHLEEN MARY (FNPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:GATES
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6700
Mailing Address - Country:US
Mailing Address - Phone:307-632-6403
Mailing Address - Fax:307-632-6426
Practice Address - Street 1:1202 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6700
Practice Address - Country:US
Practice Address - Phone:307-632-6403
Practice Address - Fax:307-632-6426
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20544Medicare ID - Type Unspecified
WYS31502Medicare UPIN