Provider Demographics
NPI:1346555398
Name:BARNUM, KATHLEEN BERGDOLT (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:BERGDOLT
Last Name:BARNUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20582 MATTERHORN DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-8911
Mailing Address - Country:US
Mailing Address - Phone:812-637-1438
Mailing Address - Fax:
Practice Address - Street 1:427 W EADS PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1139
Practice Address - Country:US
Practice Address - Phone:812-537-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28118871A163WP0808X
OHRN-131648163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health