Provider Demographics
NPI:1902162001
Name:NALL, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:NALL
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 1:3133 PROPHECY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NC
Mailing Address - Zip Code:27557-7984
Mailing Address - Country:US
Mailing Address - Phone:252-883-7968
Mailing Address - Fax:888-393-2093
Practice Address - Street 1:2024 JOELENE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-1533
Practice Address - Country:US
Practice Address - Phone:252-883-7968
Practice Address - Fax:888-393-2093
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist