Provider Demographics
NPI:1588664494
Name:FERNER, KATHRYN EILEEN (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EILEEN
Last Name:FERNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2724
Mailing Address - Country:US
Mailing Address - Phone:859-341-4480
Mailing Address - Fax:859-426-0109
Practice Address - Street 1:16 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2724
Practice Address - Country:US
Practice Address - Phone:859-341-4480
Practice Address - Fax:859-426-0109
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY562103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCP00025Medicare ID - Type Unspecified