Provider Demographics
NPI:1164864724
Name:BARON, KATHLEEN ANN (APRN, CNP, FNP, PNP)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:BARON
Suffix:
Gender:F
Credentials:APRN, CNP, FNP, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FIRTH
Mailing Address - State:ID
Mailing Address - Zip Code:83236-1168
Mailing Address - Country:US
Mailing Address - Phone:208-346-6614
Mailing Address - Fax:208-346-6638
Practice Address - Street 1:114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FIRTH
Practice Address - State:ID
Practice Address - Zip Code:83236-1168
Practice Address - Country:US
Practice Address - Phone:208-346-6614
Practice Address - Fax:208-346-6638
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1291A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily