Provider Demographics
NPI:1003650490
Name:WILLARD, KATERN SUE
Entity type:Individual
Prefix:
First Name:KATERN
Middle Name:SUE
Last Name:WILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FAWN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MAIDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26541-7218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 FAWN MEADOW DR
Practice Address - Street 2:
Practice Address - City:MAIDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26541-7218
Practice Address - Country:US
Practice Address - Phone:304-282-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide