Provider Demographics
NPI:1184891194
Name:LLOYD, KATHLEEN SWEENEY
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SWEENEY
Last Name:LLOYD
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 1:650 MAIN DRAG WAY
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-4063
Mailing Address - Country:US
Mailing Address - Phone:301-728-4518
Mailing Address - Fax:
Practice Address - Street 1:650 MAIN DRAG WAY
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425-4063
Practice Address - Country:US
Practice Address - Phone:301-728-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV43391163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9702110000Medicaid