Provider Demographics
NPI:1538436290
Name:BRINK, KATHRYN (C-PRSS)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:BRINK
Suffix:
Gender:F
Credentials:C-PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 E 3RD ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003
Mailing Address - Country:US
Mailing Address - Phone:918-766-5588
Mailing Address - Fax:
Practice Address - Street 1:914 E 3RD ST
Practice Address - Street 2:APT 2
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003
Practice Address - Country:US
Practice Address - Phone:918-766-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK108327172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker