Provider Demographics
NPI:1437870953
Name:WALES, KATHRYN LYNN (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNN
Last Name:WALES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:WALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2485 NOTRE DAME BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7161
Mailing Address - Country:US
Mailing Address - Phone:949-357-8374
Mailing Address - Fax:
Practice Address - Street 1:2012 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-6727
Practice Address - Country:US
Practice Address - Phone:530-966-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily