Provider Demographics
NPI:1194370023
Name:HUSKEY, KATHRYN LORRAINE
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LORRAINE
Last Name:HUSKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 HAGUE RD
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:ID
Mailing Address - Zip Code:83645-5111
Mailing Address - Country:US
Mailing Address - Phone:208-390-0271
Mailing Address - Fax:
Practice Address - Street 1:2421 HAGUE RD
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:ID
Practice Address - Zip Code:83645-5111
Practice Address - Country:US
Practice Address - Phone:208-390-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider