| Doctor Name: | MS. KATHERINE KILCHMANN BALTAZAR |
| NPI Number: | 1043444672 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PMHNP |
| License Number: | SP010164 |
| Business Practice Address: | 24276 166th Airport Rd Eagle Butte, SD - 576250476 |
| Business Phone Number: | 2679799524 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1012, EAGLE BUTTE |
| State: | SD |
| Postal Code: | 576251012 |
| Phone Number: | 2679799524 |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2009 |
| NPI Last Update Date: | 06/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | SP010164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |