Provider Demographics
NPI:1538231204
Name:MATES, KATHIE ANN (CRNP)
Entity type:Individual
Prefix:MS
First Name:KATHIE
Middle Name:ANN
Last Name:MATES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 JAMISON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5438
Mailing Address - Country:US
Mailing Address - Phone:724-834-7771
Mailing Address - Fax:
Practice Address - Street 1:935 THORN RUN RD
Practice Address - Street 2:W201
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2861
Practice Address - Country:US
Practice Address - Phone:724-266-6897
Practice Address - Fax:412-269-7985
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101556682 0001Medicaid
PAQ59430Medicare UPIN
PA096818QPFMedicare ID - Type UnspecifiedCRNP