Provider Demographics
NPI:1093076259
Name:CATHEY, SHANTRIA PATRICE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHANTRIA
Middle Name:PATRICE
Last Name:CATHEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 MCMEEN CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2091
Mailing Address - Country:US
Mailing Address - Phone:615-794-1542
Mailing Address - Fax:615-595-1214
Practice Address - Street 1:1324 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3784
Practice Address - Country:US
Practice Address - Phone:615-794-1542
Practice Address - Fax:615-595-1214
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000061936164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse