Provider Demographics
NPI:1548892193
Name:GATHMAN, KELLY (CHES)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GATHMAN
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8627
Mailing Address - Country:US
Mailing Address - Phone:847-544-8877
Mailing Address - Fax:
Practice Address - Street 1:W227N6103 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3969
Practice Address - Country:US
Practice Address - Phone:414-566-8426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator