Provider Demographics
NPI:1427350610
Name:CROSS, KATHY LYNN (RN/PHN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:CROSS
Suffix:
Gender:F
Credentials:RN/PHN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN/PHN
Mailing Address - Street 1:11431 VALLEY FORGE WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-8283
Mailing Address - Country:US
Mailing Address - Phone:661-399-5562
Mailing Address - Fax:
Practice Address - Street 1:1800 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3302
Practice Address - Country:US
Practice Address - Phone:661-868-0306
Practice Address - Fax:661-868-0290
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse