Kathleen Willis-Farmer, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

19916 Issued in CA

Practice address

10590 Enduring Freedom Drive
Fort Drum, NY 13602

Phone

(315) 772-6234

NPI assigned

May 29, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1578054367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10590 ENDURING FREEDOM DRIVE",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10590 ENDURING FREEDOM DRIVE",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "315-772-6234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS-FARMER",
        "first_name": "KATHLEEN",
        "credential": "RDH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-29",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "19916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MILITARY BASE",
            "identifier": "19916",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryan Dylan Wheeler, PA-C
• Caryn White, LCSW
• Julie White
• Luther Roswell Wiest, D.O.
• Mechia M. Williams, LCSW
• Roy Wilms, R.N.
• Keith Jonathan Wilson, DDS
• Kristin Leeann Wilson, ATC, LAT
• Jonah Sidney Winakor, MD
• Anton Roy Wineman Jr., PA-C

• Dental Hygienist in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Dental Hygienist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.