Provider Demographics
NPI:1861261091
Name:SOUTHARD, KATHRYN DUGGER (RN, CLC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DUGGER
Last Name:SOUTHARD
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 TYLERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-2569
Mailing Address - Country:US
Mailing Address - Phone:785-727-5217
Mailing Address - Fax:
Practice Address - Street 1:1532 TYLERTOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-2569
Practice Address - Country:US
Practice Address - Phone:785-727-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN257886163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant