| Doctor Name: | MRS. KATHLEEN ANNE RUSSELL |
| NPI Number: | 1023375276 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP-BC |
| License Number: | ARNP 2172092 |
| Business Practice Address: | 6400 Saint Johns Ave Palatka, FL - 321776817 |
| Business Phone Number: | 9042792200 |
| Business Fax Number: | |
| Mailing Address: | 6400 Saint Johns Ave, PALATKA |
| State: | FL |
| Postal Code: | 321776817 |
| Phone Number: | 9042792200 |
| Fax Number: | |
| NPI Enumeration Date: | 04/12/2012 |
| NPI Last Update Date: | 04/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | ARNP 2172092 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |