Provider Demographics
NPI: | 1477223576 |
---|---|
Name: | WARD, KATHERINE (APRN, FNP-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | KATHERINE |
Middle Name: | |
Last Name: | WARD |
Suffix: | |
Gender: | F |
Credentials: | APRN, FNP-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 8881 FLETCHER PARKWAY |
Mailing Address - Street 2: | ST. 200 |
Mailing Address - City: | LA MESA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91942-5705 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 619-464-6434 |
Mailing Address - Fax: | 760-827-7225 |
Practice Address - Street 1: | 8881 FLETCHER PARKWAY |
Practice Address - Street 2: | ST. 200 |
Practice Address - City: | LA MESA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91942-5705 |
Practice Address - Country: | US |
Practice Address - Phone: | 619-464-6434 |
Practice Address - Fax: | 760-827-7225 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2021-09-20 |
Last Update Date: | 2022-09-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | NP95017921 | 363LP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 95112294 | Other | CALIFORNIA BOARD OF REGISTERED NURSING |
CA | NP95017921 | Other | CALIFORNIA BOARD OF REGISTERED NURSING |