Basic Information
| Provider Information | |||||||||
| NPI: | 1346555398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNUM | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | BERGDOLT | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20582 MATTERHORN DR | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470258911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126371438 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 427 W EADS PKWY | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470251139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125377375 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2010 | ||||||||
| LastUpdateDate: | 08/15/2010 | ||||||||
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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 | 163WP0808X | 28118871A | IN | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0808X | RN-131648 | OH | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.