Provider Demographics
NPI:1730816794
Name:SKINNER, KATHLEEN M (CNA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:SKINNER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 HIGHWAY 120
Mailing Address - Street 2:
Mailing Address - City:BUMPUS MILLS
Mailing Address - State:TN
Mailing Address - Zip Code:37028-6026
Mailing Address - Country:US
Mailing Address - Phone:931-272-6466
Mailing Address - Fax:
Practice Address - Street 1:250 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5186
Practice Address - Country:US
Practice Address - Phone:931-272-6466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN186644376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide