Provider Demographics
NPI:1801778899
Name:PLUNK, KATHLEEN DAWN (LMT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DAWN
Last Name:PLUNK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:DAWN
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1695 MOORE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BRUCETON
Mailing Address - State:TN
Mailing Address - Zip Code:38317-7303
Mailing Address - Country:US
Mailing Address - Phone:309-258-3183
Mailing Address - Fax:
Practice Address - Street 1:1695 MOORE CREEK RD
Practice Address - Street 2:
Practice Address - City:BRUCETON
Practice Address - State:TN
Practice Address - Zip Code:38317-7303
Practice Address - Country:US
Practice Address - Phone:309-258-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227020596225700000X
TN15209225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist