Provider Demographics
NPI:1144377342
Name:VANCLEAVE, KATHRYN ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:VANCLEAVE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:365 LENNON LN 250
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5915
Mailing Address - Country:US
Mailing Address - Phone:925-932-6330
Mailing Address - Fax:
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:SUITE A-308
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-436-8700
Practice Address - Fax:760-436-8937
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP17029OtherNURSE PRACTITIONER