MEDICARE: KATHRYN EILEEN FERNER PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	562	KY

General Provider Information

NPI Number	:	1588664494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN EILEEN FERNER PSY.D.

Provider Business Mailing Address
First Line	:	16 WOODLAWN AVE
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-2724
Country	:	US
Telephone Number	:	859-341-4480
Fax Number	:	859-426-0109

Provider Business Practice Location Address
First Line	:	16 WOODLAWN AVE
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-2724
Country	:	US
Telephone Number	:	859-341-4480
Fax Number	:	859-426-0109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/19/2010

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