KATHY L DOMIANO (NPI# 1265627970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265627970 |
| Entity Type | Individual |
| Full Name | KATHY L DOMIANO |
| Credential | FNP |
| Practice Address |
504 Nw 10th Ave Ava MO 65608 |
| Mailing Address |
504 Nw 10th Ave Po Box 1359 Ava MO 65608 |
| Practice Telephone | 4176834831 |
| Practice Fax Number | 4176831602 |
| Mailing Telephone | 4176834831 |
| Mailing Fax Number | 4176831602 |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2008-03-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
154500 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
504 NW 10TH AVE |
| City | AVA |
| State | MO |
| Zip Code | 65608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386619252 | Jerriann Coxson | Nurse Practitioner | 504 Nw 10th Ave, Ava, MO 65608 | 2006-02-22 |
| 1871797597 | Douglas County Public Health Services Group, Inc. | Clinic/Center | 504 Nw 10th Ave, Ava, MO 65608 | 2007-06-14 |
| 1568665883 | Sybil Ann Fortner | Dentist | 504 Nw 10th Ave, Ava, MO 65608 | 2007-06-06 |
| 1649332545 | Teresa Lynn Sherard | Internal Medicine | 504 Nw 10th Ave, Ava, MO 65608-0000 | 2006-12-15 |
| 1508896325 | Brian Thomas Lenihan | Physician Assistant | 504 Nw 10th Ave, Ava, MO 65608 | 2006-07-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306326871 | Regional Services | Nurse Practitioner | 507 Ne 3rd St, Ava, MO 65608 | 2018-08-15 |
| 1629558168 | Smith Management Services, LLC | Durable Medical Equipment & Medical Supplies | 916 N.w. Springfield Ave, Suite F, Ava, MO 65608 | 2018-08-15 |
| 1235639592 | Carolyn Marie Myers | Occupational Therapist | 223 South Jefferson Street, Ava, MO 65608 | 2018-02-13 |
| 1114386497 | Judy King | Counselor | 202 Nw Str Str 1, Ava, MO 65608 | 2016-02-16 |
| 1548653009 | Grace Smith | Pharmacist | 124 West Washington Avenue, Ava, MO 65608 | 2015-03-09 |
| 1427397769 | Rebecca L Mcbride | Nurse Practitioner | 120 W Lincoln Ave, Ava, MO 65608 | 2013-02-06 |
| 1154695716 | Medical Equipment Inspection & Repair | Durable Medical Equipment & Medical Supplies | 122 East Washington Ave, Ava, MO 65608 | 2012-02-29 |
| 1932471695 | Lacinda Kaye Higley | Mechanotherapist | 603 North West 10th Ave, Ava, MO 65608 | 2012-01-27 |
| 1972812592 | Douglas County Public Health Services Group, Inc. | Clinic/Center | 603 Nw 10th Ave., Ava, MO 65608 | 2010-09-30 |
| 1013224047 | Family Pharmacy Inc. | Durable Medical Equipment & Medical Supplies | 916 N.w. 12th Ave, Suite F, Ava, MO 65608 | 2010-09-13 |
| Find all providers in zip 65608 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493275 | Destemona Bozhani-marte | Nurse Practitioner | 5804 Sw Bray Rd, Clarksdale, MO 64430-9176 | 2020-10-07 |
| 1437760675 | Justin Lucas Sweetin | Nurse Practitioner | 7727 Weston Pl, Richmond Heights, MO 63117-2018 | 2020-08-12 |
| 1962043802 | Bonne Terre Healthcare Clinic, LLC | Nurse Practitioner | 11 S Division St Ste A, Bonne Terre, MO 63628-1701 | 2019-10-02 |
| 1720639354 | Anne Nicole Dailey | Nurse Practitioner | 2330 E Meyer Blvd Ste T411, Kansas City, MO 64132-1162 | 2019-09-25 |
| 1326694605 | Affirm Management and Consulting, LLC | Nurse Practitioner | 4728 S Campbell Ave Ste 128, Springfield, MO 65810-1715 | 2019-08-13 |
| 1588122311 | Meskerm Workiye Asfaw | Nurse Practitioner | 589 Vintage Grove Ct, Wildwood, MO 63038-2314 | 2019-03-11 |
| 1063983088 | Jenny Lynette Brown | Nurse Practitioner | 6912 Candlewick Way, Florissant, MO 63033-5113 | 2018-12-17 |
| 1992270011 | Andrew Joseph Gucciardo | Nurse Practitioner | 12348 Old Tesson Rd Ste 250, Saint Louis, MO 63128-2261 | 2018-10-04 |
| 1679065098 | Aaron Dewayne Gitthens | Nurse Practitioner | 898 Sw State Route O, Osborn, MO 64474-9762 | 2018-06-01 |
| 1548763121 | Jennifer Williams | Nurse Practitioner | 4618 Colima Ct, Saint Louis, MO 63128-2309 | 2018-03-09 |
| Find all providers with the same taxonomy | ||||
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| 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.