Provider Demographics
NPI:1376522474
Name:CARROLL, KATHY ANN C (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHY ANN
Middle Name:C
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:970 PACIFIC HILLS PT
Mailing Address - Street 2:D204
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8424
Mailing Address - Country:US
Mailing Address - Phone:719-524-2205
Mailing Address - Fax:719-524-2258
Practice Address - Street 1:7490 SUTHERLAND CR
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-7764
Practice Address - Fax:719-524-2258
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28104911A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse