Healthcare Provider Details

I. General information

NPI: 1609222850
Provider Name (Legal Business Name): KATHRYN AURORA HEADLEY CPPM,QPIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST STE 210
HOLLYWOOD FL
33026-1531
US

IV. Provider business mailing address

270 SW 112TH TER
PEMBROKE PINES FL
33025-3410
US

V. Phone/Fax

Practice location:
  • Phone: 954-552-6668
  • Fax:
Mailing address:
  • Phone: 954-449-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: