Provider Demographics
NPI:1992188734
Name:GILLIAM, KATHERINE HINDMAN (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HINDMAN
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:HINDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1708
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:
Practice Address - Street 1:1405 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8857
Practice Address - Country:US
Practice Address - Phone:270-725-9700
Practice Address - Fax:270-725-9992
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3494207Q00000X
KY04068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine