Provider Demographics
NPI:1447469192
Name:COLE, KATHERINE SOFIA (DO)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SOFIA
Last Name:COLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:COLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5900 DOWDELL AVE
Mailing Address - Street 2:#159
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928
Mailing Address - Country:US
Mailing Address - Phone:913-339-8887
Mailing Address - Fax:
Practice Address - Street 1:5900 DOWDELL AVE
Practice Address - Street 2:#159
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-4127
Practice Address - Country:US
Practice Address - Phone:913-339-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090284622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS05-34557OtherSTATE :ICENSE
MO2009028462OtherMISSOURI LICENSE