Provider Demographics
NPI:1033439203
Name:BORLAND, KATHRYN LACY
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LACY
Last Name:BORLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:LACY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1004 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4330
Mailing Address - Country:US
Mailing Address - Phone:870-423-1077
Mailing Address - Fax:870-423-1087
Practice Address - Street 1:1004 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4330
Practice Address - Country:US
Practice Address - Phone:870-423-1077
Practice Address - Fax:870-423-1087
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator