Basic Information
| Provider Information | |||||||||
| NPI: | 1265608376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 EAST PALOMA DRIVE | ||||||||
| Address2: | RT 2 BOX 1G | ||||||||
| City: | NAHUNTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315539601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124626289 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 HIGHWAY 89 NORTH | ||||||||
| Address2: | N AZ VA HEALTH CARE SYSTEM | ||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2008 | ||||||||
| LastUpdateDate: | 05/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN031551 | GA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.