Provider Demographics
NPI:1609157353
Name:CUSTER, KATHLEEN H (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:H
Last Name:CUSTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:HUNGERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1905 CLINT MOORE ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2659
Mailing Address - Country:US
Mailing Address - Phone:561-989-9070
Mailing Address - Fax:561-989-0255
Practice Address - Street 1:1905 CLINT MOORE ROAD
Practice Address - Street 2:SUITE 212
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2659
Practice Address - Country:US
Practice Address - Phone:561-989-9070
Practice Address - Fax:561-989-0255
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1518292363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health