Provider Demographics
NPI:1093185936
Name:MUIR, KATHLEEN SARAH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SARAH
Last Name:MUIR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:SARAH
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BLDG 301 ANDREWS AVE
Mailing Address - Street 2:LYSTER ARMY HEALTH CLINIC
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7341
Mailing Address - Fax:334-255-7368
Practice Address - Street 1:9040 REID STREET, ATTN: MCHJ-CLQ-C
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1000
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:877-874-1031
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP043776164W00000X
AL2-070401164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse