Healthcare Provider Details

I. General information

NPI: 1295873545
Provider Name (Legal Business Name): KATHERINE MITCHELL HOUGH ADULT NURSE PRACTITI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 STATE RD FAMILY PLANNING OF MARDTAS VINEYARD
VINEYARD HAVEN MA
02568
US

IV. Provider business mailing address

PO BOX 281
WEST TISBURY MA
02575
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-1208
  • Fax: 508-693-1299
Mailing address:
  • Phone: 508-693-2376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN87001
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: