Provider Demographics
NPI:1558579730
Name:IRVIN, KATHY A (LPN)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:A
Last Name:IRVIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4576 IRISH RIDGE RD SE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:OH
Mailing Address - Zip Code:43730-9732
Mailing Address - Country:US
Mailing Address - Phone:740-347-4863
Mailing Address - Fax:
Practice Address - Street 1:4576 IRISH RIDGE RD SE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:OH
Practice Address - Zip Code:43730-9732
Practice Address - Country:US
Practice Address - Phone:740-347-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN093312164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse