| Doctor Name: | KATHY L DOMIANO |
| NPI Number: | 1265627970 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 154500 |
| Business Practice Address: | 504 Nw 10th Ave Ava, MO - 65608 |
| Business Phone Number: | 4176834831 |
| Business Fax Number: | 4176831602 |
| Mailing Address: | 504 Nw 10th Ave, Po Box 1359 AVA |
| State: | MO |
| Postal Code: | 65608 |
| Phone Number: | 4176834831 |
| Fax Number: | 4176831602 |
| NPI Enumeration Date: | 09/06/2007 |
| NPI Last Update Date: | 03/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 154500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |