Provider Demographics
NPI:1154776441
Name:DRIVER, KATINA
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:
Last Name:DRIVER
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 1:2 LEE ROAD 2193
Mailing Address - Street 2:
Mailing Address - City:CUSSETA
Mailing Address - State:AL
Mailing Address - Zip Code:36852-2827
Mailing Address - Country:US
Mailing Address - Phone:334-332-3845
Mailing Address - Fax:
Practice Address - Street 1:2 LEE ROAD 2193
Practice Address - Street 2:
Practice Address - City:CUSSETA
Practice Address - State:AL
Practice Address - Zip Code:36852-2827
Practice Address - Country:US
Practice Address - Phone:334-332-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 3747P1801X, 376K00000X
AL376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide