Provider Demographics
NPI:1093714594
Name:HARVEY, KATHLEEN D (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:HARVEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:D
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:925 N KNOB CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-6039
Mailing Address - Country:US
Mailing Address - Phone:865-368-4556
Mailing Address - Fax:
Practice Address - Street 1:925 N KNOB CREEK RD
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-6039
Practice Address - Country:US
Practice Address - Phone:865-368-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000109236171W00000X
TN041310367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
12557517OtherPHCS
KY7100048360Medicaid
IN200952870Medicaid
OH3073801Medicaid
61107736900137366398OtherHEALTHNET
IN200952870Medicaid
OH3073801Medicaid
IN200952870Medicaid
KY7100048360Medicaid
OHH169950Medicare PIN
0918162Medicare PIN