Provider Demographics
NPI:1992957104
Name:KENNETT, KATHERINE GRADY (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:GRADY
Last Name:KENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1919
Mailing Address - Country:US
Mailing Address - Phone:845-294-9278
Mailing Address - Fax:845-294-1044
Practice Address - Street 1:150 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1919
Practice Address - Country:US
Practice Address - Phone:845-294-9278
Practice Address - Fax:845-294-1044
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303648-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice