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Individual
KATHY G LIDDY
Active
Individual
KATHY G LIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
71000929A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71000929A
IN
363LG0600X
Gerontology Nurse Practitioner
71000929A
IN
Other
Enumeration date
06/15/2006
Last updated
08/23/2017
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