Provider Demographics
NPI:1225388861
Name:CHILTON, KATHRYN JANE I (LMT, RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JANE
Last Name:CHILTON
Suffix:I
Gender:F
Credentials:LMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 ANDREWS ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1857
Mailing Address - Country:US
Mailing Address - Phone:315-842-2714
Mailing Address - Fax:
Practice Address - Street 1:96 ANDREWS ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1857
Practice Address - Country:US
Practice Address - Phone:315-842-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27016102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist