Provider Demographics
NPI:1376699017
Name:FRIEND, KATHLEEN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:FRIEND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5093 EL CLARO E
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-2701
Mailing Address - Country:US
Mailing Address - Phone:561-601-4151
Mailing Address - Fax:561-478-7426
Practice Address - Street 1:217 W AVENUE A
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3019
Practice Address - Country:US
Practice Address - Phone:561-992-4888
Practice Address - Fax:561-996-4358
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1169282207Q00000X
FLARNP1169282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101490800Medicaid
FL301829601Medicaid