Provider Demographics
NPI:1649605080
Name:FLAHERTY, KATHLEEN (PHD, CNS, RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:PHD, CNS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CLEVELAND AVE NW
Mailing Address - Street 2:RH 201G
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 CLEVELAND AVE NW
Practice Address - Street 2:RH 201G
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3308
Practice Address - Country:US
Practice Address - Phone:330-471-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189642364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health