MS. MARY KATHRYN DOUGLAS (NPI# 1114928637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114928637 |
| Entity Type | Individual |
| Full Name | MS. MARY KATHRYN DOUGLAS |
| Credential | PAC |
| Practice Address |
5015 N Royal Dr Traverse City MI 49684-9292 |
| Practice Telephone | 2319350850 |
| Practice Fax Number | 2319350869 |
| Mailing Telephone | 2319350850 |
| Mailing Fax Number | 2319350869 |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2020-10-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
MD003850 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316257066 | Mary Afton Douglas | Massage Therapist | 600 A Madison Street, Huntsville, AL 35801 | 2010-10-15 |
| 1124359393 | Mary Abigail Douglas | Counselor | 5309 Village Creek Dr, Suite 103, Plano, TX 75093-4841 | 2010-01-27 |
| 1053925479 | Mary Douglas | Behavior Technician | 15501 Weston Pkwy Ste 130, Cary, NC 27513-8641 | 2020-09-02 |
| 1982123857 | Mary Elizabeth Douglas | Nutritionist | 15965 Ne 85th St Ste 102, Redmond, WA 98052-3593 | 2017-09-12 |
| 1942736228 | Mary Douglas | Community Health Worker | 5455 Almira Dr Ne, Bremerton, WA 98311-8330 | 2017-05-05 |
| 1801332481 | Mary E Douglas | Perfusionist | 31330 Schoolcraft Rd, Ste 200, Livonia, MI 48150-2041 | 2017-01-06 |
| 1730436098 | Mary E Douglas | Social Worker | 3043 State Route 4, Hudson Falls, NY 12839-9632 | 2012-08-06 |
| 1801921978 | Mary Kathyn Douglas | Speech-Language Pathologist | 1901 E Hamilton St, Kirksville, MO 63501-3904 | 2007-02-22 |
| 1861545543 | Mary Douglas | Pharmacist | 200 Westage Business Ctr Dr, Fishkill, NY 12524-2264 | 2007-01-18 |
| 1891842274 | Mary Douglas | Occupational Therapist | 1112 Caroline St, Port Angeles, WA 98362-4204 | 2007-01-05 |
| Street Address |
5015 N ROYAL DR |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-9292 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346687183 | Adrienne B Wagner | Family Medicine | 5015 N Royal Dr, Traverse City, MI 49684-9292 | 2013-06-03 |
| 1811943723 | Elizabeth L Hughes | Family Medicine | 5015 N Royal Dr, Traverse City, MI 49684-9292 | 2006-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992810360 | Laura Leigh Worthington | Physician Assistant | 13491 S Bugai Rd, Traverse City, MI 49684-8421 | 2006-08-19 |
| 1598752768 | Perry Ray Tiernan | Physician Assistant | 3074 Us 31 S, Traverse City, MI 49684-4533 | 2005-10-04 |
| 1043857196 | Derek Hendrickson | Physician Assistant | 1200 Sixth St Ste 200, Traverse City, MI 49684-2369 | 2019-12-09 |
| 1649735226 | Morgan Kelsey Olson | Physician Assistant | 1105 Sixth St, Traverse City, MI 49684-2345 | 2019-02-07 |
| 1851833198 | Katharine Ella Venner | Physician Assistant | 1105 6th St, Traverse City, MI 49684-2349 | 2016-11-16 |
| 1427417708 | Christine E Miliken | Physician Assistant | 3074 N Us 31 S, Traverse City, MI 49684-4533 | 2016-02-16 |
| 1144503491 | Jesse Kogelman | Physician Assistant | 550 Munson Ave, Suite 200, Traverse City, MI 49686-3580 | 2011-09-22 |
| 1952691768 | Alisha Marie Cole | Physician Assistant | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2011-04-13 |
| 1467606350 | Carrie M Sorensen | Physician Assistant | 1200 Sixth St Ste 200, Traverse City, MI 49684-2369 | 2008-11-05 |
| 1336397538 | Andrij Ihor Lawrin | Physician Assistant | 1105 Sixth St, Traverse City, MI 49684-2345 | 2008-09-03 |
| Find all providers in TRAVERSE CITY | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
Please comment or provide details below to improve the information on MS. MARY KATHRYN DOUGLAS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.