Provider Demographics
NPI:1609104660
Name:JAMES, KATHY HICKMAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:HICKMAN
Last Name:JAMES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9737
Mailing Address - Country:US
Mailing Address - Phone:304-757-3799
Mailing Address - Fax:
Practice Address - Street 1:2038 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9737
Practice Address - Country:US
Practice Address - Phone:304-757-3799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV48534367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered