MEDICARE: MS. KATHRYN AURORA HEADLEY CPPM,QPIN

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	174H00000X	Health Educator
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1609222850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN AURORA HEADLEY CPPM,QPIN

Provider Business Mailing Address
First Line	:	270 SW 112TH TER
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-3410
Country	:	US
Telephone Number	:	954-449-3740
Fax Number	:

Provider Business Practice Location Address
First Line	:	11011 SHERIDAN ST STE 210
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1531
Country	:	US
Telephone Number	:	954-552-6668
Fax Number	:

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

Provider Enumeration Date	:	05/06/2016
Last Update Date	:	12/27/2024

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