Provider Demographics
NPI:1538373618
Name:VENEMA, KATHRYN JOAN (RPT,MS)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JOAN
Last Name:VENEMA
Suffix:
Gender:F
Credentials:RPT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:TONTITOWN
Mailing Address - State:AR
Mailing Address - Zip Code:72770-0871
Mailing Address - Country:US
Mailing Address - Phone:479-751-3900
Mailing Address - Fax:
Practice Address - Street 1:1112 S 48TH ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5886
Practice Address - Country:US
Practice Address - Phone:479-751-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1932208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U231OtherABCBS PROVIDER NUMBER
AR135578721Medicaid