Provider Demographics
NPI:1417587742
Name:DUFFY, KATHLEEN KEALY (LAC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KEALY
Last Name:DUFFY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 CHICON ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2113
Mailing Address - Country:US
Mailing Address - Phone:206-595-8246
Mailing Address - Fax:
Practice Address - Street 1:1209 CHICON ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2113
Practice Address - Country:US
Practice Address - Phone:617-519-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01643171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty