Provider Demographics
NPI:1487912523
Name:HEARSEY, KATHLEEN ANNE (MED)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:HEARSEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CB # 7180
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7180
Mailing Address - Country:US
Mailing Address - Phone:919-966-8187
Mailing Address - Fax:919-966-4127
Practice Address - Street 1:101 RENEE LYNN CT
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-6511
Practice Address - Country:US
Practice Address - Phone:919-966-8187
Practice Address - Fax:919-966-4127
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst