Provider Demographics
NPI:1295873545
Name:HOUGH, KATHERINE MITCHELL (ADULT NURSE PRACTITI)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MITCHELL
Last Name:HOUGH
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575
Mailing Address - Country:US
Mailing Address - Phone:508-693-2376
Mailing Address - Fax:
Practice Address - Street 1:322 STATE RD
Practice Address - Street 2:FAMILY PLANNING OF MARDTAS VINEYARD
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-1208
Practice Address - Fax:508-693-1299
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN87001363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P74649Medicare UPIN
NP4000Medicare ID - Type Unspecified