Provider Demographics
NPI:1780324293
Name:HANSEN, KATHLEEN JOY (DO)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JOY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1111
Mailing Address - Country:US
Mailing Address - Phone:334-440-3061
Mailing Address - Fax:334-557-1057
Practice Address - Street 1:2024 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1111
Practice Address - Country:US
Practice Address - Phone:334-440-3061
Practice Address - Fax:334-557-1057
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program