Provider Demographics
NPI:1093962094
Name:WITHERLY, KAREN ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:WITHERLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 SHEARWATER WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7711
Mailing Address - Country:US
Mailing Address - Phone:760-721-7018
Mailing Address - Fax:
Practice Address - Street 1:4402 SHEARWATER WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-7711
Practice Address - Country:US
Practice Address - Phone:760-721-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226772363LF0000X
TX598235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily