Provider Demographics
NPI:1376296251
Name:FARRIS, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FARRIS
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 1:598 GEIGER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29904
Mailing Address - Country:US
Mailing Address - Phone:843-228-7424
Mailing Address - Fax:
Practice Address - Street 1:MARINE CORPS AIR STATION BEAUFORT
Practice Address - Street 2:598 GEIGER BOULEVARD
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29904
Practice Address - Country:US
Practice Address - Phone:843-228-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101279322208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice