Provider Demographics
NPI:1316111883
Name:HODKINSON, KATHY KAY (LPN)
Entity type:Individual
Prefix:MISS
First Name:KATHY
Middle Name:KAY
Last Name:HODKINSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3424
Mailing Address - Country:US
Mailing Address - Phone:315-788-4479
Mailing Address - Fax:
Practice Address - Street 1:508 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3424
Practice Address - Country:US
Practice Address - Phone:315-788-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111538-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse