Provider Demographics
NPI:1659506889
Name:ADDINGTON, KATHEY ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHEY
Middle Name:ANN
Last Name:ADDINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:KATHEY
Other - Middle Name:ANN
Other - Last Name:HARTZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2 TERRITORY RD
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-9304
Mailing Address - Country:US
Mailing Address - Phone:315-829-8700
Mailing Address - Fax:315-829-8730
Practice Address - Street 1:2 TERRITORY RD
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-9304
Practice Address - Country:US
Practice Address - Phone:315-829-8700
Practice Address - Fax:315-829-8730
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267739-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01705682Medicaid
NY01705682Medicaid