Provider Demographics
NPI:1629877055
Name:GREGORY, KATHERINE ROSE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSE
Last Name:GREGORY
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 1:3121 ROSEWOOD DR APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3476
Mailing Address - Country:US
Mailing Address - Phone:847-404-3173
Mailing Address - Fax:
Practice Address - Street 1:6311 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1445
Practice Address - Country:US
Practice Address - Phone:803-216-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program