Provider Demographics
NPI:1871545582
Name:HEAD, KATHLEEN A (APRN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:HEAD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:MCELROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNCS
Mailing Address - Street 1:USC THOMSON STUDENT HEALTH CENTER
Mailing Address - Street 2:GREENE STREET ROOM 302
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-0001
Mailing Address - Country:US
Mailing Address - Phone:803-777-5373
Mailing Address - Fax:803-777-6965
Practice Address - Street 1:USC THOMSON STUDENT HEALTH CENTER
Practice Address - Street 2:GREENE STREET ROOM 302
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-5373
Practice Address - Fax:803-777-6965
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR50692364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA65896580OtherMEDICARE PTAN
SCNP0416Medicaid
SCNP0416Medicaid