Provider Demographics
NPI:1235221854
Name:DISHNER, KATHLEEN A (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:DISHNER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 COMMERCIAL STREET
Mailing Address - Street 2:SUITE C HARBOR FAMILY SERVICES
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856
Mailing Address - Country:US
Mailing Address - Phone:207-470-7090
Mailing Address - Fax:207-470-7094
Practice Address - Street 1:62 BAYVIEW ST UNIT 23
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843
Practice Address - Country:US
Practice Address - Phone:207-706-4163
Practice Address - Fax:207-706-4172
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER019254363LP0808X
MECNP81733363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P44098Medicare UPIN
NS8106Medicare ID - Type Unspecified