Provider Demographics
NPI:1447593405
Name:LITTLE, KATHERINE KENDALL (NP)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:KENDALL
Last Name:LITTLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 OAKLEDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6937
Mailing Address - Country:US
Mailing Address - Phone:770-419-3806
Mailing Address - Fax:
Practice Address - Street 1:4489 ACWORTH INDUSTRIAL DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5656
Practice Address - Country:US
Practice Address - Phone:770-974-3330
Practice Address - Fax:770-966-9192
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085489363LW0102X, 364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000000OtherNONE