Provider Demographics
NPI:1215082458
Name:LAWLESS, KATHY KENNEDY (RN, APN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:KENNEDY
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:SUZIE
Other - Middle Name:
Other - Last Name:LAWLESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, APN
Mailing Address - Street 1:255 COUNTY ROAD 496
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-5274
Mailing Address - Country:US
Mailing Address - Phone:225-719-2540
Mailing Address - Fax:
Practice Address - Street 1:255 COUNTY ROAD 496
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-5274
Practice Address - Country:US
Practice Address - Phone:225-719-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR086276163W00000X
LARN087116163W00000X
ARA003831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse