Basic Information
| Provider Information | |||||||||
| NPI: | 1194758359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOVILLE | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | LEAH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | DH - FAMILY MEDICINE | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545454 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | DH - FAMILY MEDICINE | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545454 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 05/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 039698-23-03 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APN0000013549 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 30343904 | 05 | NH | MEDICAID |