Provider Demographics
NPI:1235385154
Name:HARTER, KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:HARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 32990
Mailing Address - Street 2:FORD MEDICAL
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40232-2990
Mailing Address - Country:US
Mailing Address - Phone:502-364-3633
Mailing Address - Fax:502-364-3438
Practice Address - Street 1:2000 FERN VALLEY RD
Practice Address - Street 2:FORD MEDICAL
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3502
Practice Address - Country:US
Practice Address - Phone:502-364-3633
Practice Address - Fax:502-364-3438
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY234922083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine