Individual
DR. KATHRYN JOY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2235 VENETIAN COURT SUITE 1, NAPLES, FL 34109
(619) 543-6268
Mailing address
2235 VENETIAN COURT SUITE 1, NAPLES, FL 34109
(239) 596-9337
(239) 596-9466
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
115577
FL
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
115577
FL
207NP0225X
Pediatric Dermatology Physician
115577
FL
207NS0135X
Procedural Dermatology Physician
115577
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/22/2009
Last updated
08/28/2020
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