Provider Demographics
NPI:1649520727
Name:HALLAM, KATHY J (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:J
Last Name:HALLAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15196 E QUAIL RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-5366
Mailing Address - Country:US
Mailing Address - Phone:417-684-7518
Mailing Address - Fax:
Practice Address - Street 1:320 N MAC BOULEVARD
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772
Practice Address - Country:US
Practice Address - Phone:417-667-2262
Practice Address - Fax:417-667-6515
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005024367163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse