Provider Demographics
NPI:1699017483
Name:FARRIS, KATHLEEN (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 COLUMBIA HWY N
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29805-9017
Mailing Address - Country:US
Mailing Address - Phone:803-641-2677
Mailing Address - Fax:803-641-2402
Practice Address - Street 1:2404 COLUMBIA HWY N
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29805-9017
Practice Address - Country:US
Practice Address - Phone:803-641-2677
Practice Address - Fax:803-641-2402
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC68765163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse