Provider Demographics
NPI:1033904776
Name:BACON, KATHERINE AMELIA (RN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AMELIA
Last Name:BACON
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 DUBOSE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-1917
Mailing Address - Country:US
Mailing Address - Phone:706-338-5668
Mailing Address - Fax:
Practice Address - Street 1:374 DUBOSE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1917
Practice Address - Country:US
Practice Address - Phone:706-338-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN283636163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology