Healthcare Provider Details

I. General information

NPI: 1235385154
Provider Name (Legal Business Name): KATHLEEN HARTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FERN VALLEY RD FORD MEDICAL
LOUISVILLE KY
40213-3502
US

IV. Provider business mailing address

PO BOX 32990 FORD MEDICAL
LOUISVILLE KY
40232-2990
US

V. Phone/Fax

Practice location:
  • Phone: 502-364-3633
  • Fax: 502-364-3438
Mailing address:
  • Phone: 502-364-3633
  • Fax: 502-364-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number23492
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: