Provider Demographics
NPI:1265608376
Name:HARRIS, KATHLEEN B (LPN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:B
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 EAST PALOMA DRIVE
Mailing Address - Street 2:RT 2 BOX 1G
Mailing Address - City:NAHUNTA
Mailing Address - State:GA
Mailing Address - Zip Code:31553-9601
Mailing Address - Country:US
Mailing Address - Phone:912-462-6289
Mailing Address - Fax:
Practice Address - Street 1:500 HIGHWAY 89 NORTH
Practice Address - Street 2:N AZ VA HEALTH CARE SYSTEM
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN031551164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse