Provider Demographics
NPI:1770289555
Name:RAPHAEL, KATHRYN CONNER (AGACNP BC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CONNER
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:AGACNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 N REMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67226-7605
Mailing Address - Country:US
Mailing Address - Phone:580-695-0130
Mailing Address - Fax:
Practice Address - Street 1:5058 N REMINGTON ST
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-7605
Practice Address - Country:US
Practice Address - Phone:267-303-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS81907363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health