Provider Demographics
NPI:1871578690
Name:EXTER, KATHERINE J (PA C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:EXTER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8161
Practice Address - Fax:717-531-7726
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000865363A00000X
PAMA003370L363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1979488OtherHIGHMARK BLUE SHIELD
PA50071496OtherCAPITAL BLUE CROSS-WMG
MD782571400Medicaid
PA1566798OtherGATEWAY-WMG
MD782571400Medicaid
PAP00459141Medicare PIN
MDK563E441Medicare PIN
PA114405FLTMedicare PIN