Provider Demographics
NPI:1427889658
Name:DEARTH, KATHLEEN DAWN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DAWN
Last Name:DEARTH
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 1:24570 KINDERHOOK RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43164-9606
Mailing Address - Country:US
Mailing Address - Phone:740-207-6443
Mailing Address - Fax:
Practice Address - Street 1:24570 KINDERHOOK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:OH
Practice Address - Zip Code:43164-9606
Practice Address - Country:US
Practice Address - Phone:740-207-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker