Provider Demographics
NPI:1710653076
Name:HERRMANN, KATHRYN KELSEY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:KELSEY
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:BLOSSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16912-0034
Mailing Address - Country:US
Mailing Address - Phone:570-638-3468
Mailing Address - Fax:570-638-3637
Practice Address - Street 1:116 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:BLOSSBURG
Practice Address - State:PA
Practice Address - Zip Code:16912-1418
Practice Address - Country:US
Practice Address - Phone:570-638-3468
Practice Address - Fax:570-638-3637
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH0012101223D0001X
PADH071683124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No1223D0001XDental ProvidersDentistDental Public Health