Provider Demographics
NPI:1376114421
Name:WHALEY, KATHLIA A (CNA)
Entity Type:Individual
Prefix:
First Name:KATHLIA
Middle Name:A
Last Name:WHALEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:KATHALIA
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:11232 CRYSTAL AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-3349
Mailing Address - Country:US
Mailing Address - Phone:913-282-3107
Mailing Address - Fax:
Practice Address - Street 1:11232 CRYSTAL AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-3349
Practice Address - Country:US
Practice Address - Phone:913-282-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health