Provider Demographics
NPI:1265755565
Name:FLAHERTY, KATHLEEN E (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:E
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:E
Other - Last Name:FERRARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:780 CANTON RD NE STE 400
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7298
Mailing Address - Country:US
Mailing Address - Phone:770-422-3602
Mailing Address - Fax:
Practice Address - Street 1:780 CANTON RD NE STE 400
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-411-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9280767363LF0000X
GARN265786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCM8550OtherMEDICARE RR
FL008581700Medicaid
FLDK044ZMedicare PIN