Provider Demographics
NPI:1952691560
Name:GRIFFITH, KATHRYN ELAINE (ARNP, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ELAINE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-0037
Mailing Address - Country:US
Mailing Address - Phone:563-949-5938
Mailing Address - Fax:877-425-4064
Practice Address - Street 1:419 N CODY ROAD
Practice Address - Street 2:
Practice Address - City:LECLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9537
Practice Address - Country:US
Practice Address - Phone:563-949-5938
Practice Address - Fax:877-425-4064
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG061979363LP0808X
IAG-061979363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health