Provider Demographics
NPI:1497197594
Name:KLADAR, KATHY KAREN (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:KAREN
Last Name:KLADAR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3786
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-3786
Mailing Address - Country:US
Mailing Address - Phone:707-206-5862
Mailing Address - Fax:707-497-3524
Practice Address - Street 1:329 LAKE HAVASU AVE S
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-9368
Practice Address - Country:US
Practice Address - Phone:928-764-7266
Practice Address - Fax:928-302-3615
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA775733163W00000X
AZ291148163W00000X, 363LF0000X
CA23302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013012247OtherAMERICAN NURSE CREDENTIALING CENTER FAMILY NURSE PRACTITIONER, BOARD CERTIFIED