Provider Demographics
NPI:1174170211
Name:GARRETT, KATHLEEN ANN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 S CLEMENTS ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-5802
Mailing Address - Country:US
Mailing Address - Phone:940-727-9749
Mailing Address - Fax:
Practice Address - Street 1:918 S CLEMENTS ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-5802
Practice Address - Country:US
Practice Address - Phone:940-727-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider