Provider Demographics
NPI:1932351871
Name:ROONEY, KATHLEEN CRAIG (APRN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CRAIG
Last Name:ROONEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:C
Other - Last Name:LYMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, C-NP
Mailing Address - Street 1:2150 MIDDLE FORK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-0446
Mailing Address - Country:US
Mailing Address - Phone:405-535-9649
Mailing Address - Fax:
Practice Address - Street 1:2150 MIDDLE FORK RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-0446
Practice Address - Country:US
Practice Address - Phone:405-535-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79730363LF0000X
AK185404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily