Individual
KATHLEEN M DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3055 INNOVATION WAY, HERMITAGE, PA 16148-7905
(814) 333-5438
(814) 333-5439
Mailing address
1034 GROVE ST, MEADVILLE, PA 16335-2945
(814) 333-5438
(814) 333-5439
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN610072
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE PTAN
PA
Enumeration date
11/26/2014
Last updated
07/31/2026
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