Provider Demographics
NPI:1700850781
Name:MCCARTHY, KATHRYN E (DNP,CNM,NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:DNP,CNM,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11105 MEADOW GLEN WAY E
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-7008
Mailing Address - Country:US
Mailing Address - Phone:619-203-8081
Mailing Address - Fax:
Practice Address - Street 1:11105 MEADOW GLEN WAY E
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-7008
Practice Address - Country:US
Practice Address - Phone:619-203-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95020047363LW0102X, 363L00000X
CARN518810367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS60819Medicare UPIN
CAWNMW1323BMedicare ID - Type UnspecifiedGROUP# W7168