Provider Demographics
NPI:1023517802
Name:WADSWORTH, KATHLEEN MOORE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MOORE
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5612 WHITESVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9031
Mailing Address - Country:US
Mailing Address - Phone:706-322-2223
Mailing Address - Fax:
Practice Address - Street 1:5612 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9031
Practice Address - Country:US
Practice Address - Phone:706-322-2223
Practice Address - Fax:706-324-5233
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily