Provider Demographics
NPI:1821397688
Name:MCKANNA, KATHERINE ROSE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ROSE
Last Name:MCKANNA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807
Mailing Address - Country:US
Mailing Address - Phone:812-231-5678
Mailing Address - Fax:812-231-4475
Practice Address - Street 1:110 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807
Practice Address - Country:US
Practice Address - Phone:812-231-5678
Practice Address - Fax:812-231-4475
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF0211087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily