Provider Demographics
NPI:1790320844
Name:ETHINGTON, KALENE MEARS (FNP-C)
Entity Type:Individual
Prefix:
First Name:KALENE
Middle Name:MEARS
Last Name:ETHINGTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KALENE
Other - Middle Name:
Other - Last Name:MEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:188 WALTERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7941
Mailing Address - Country:US
Mailing Address - Phone:509-230-8979
Mailing Address - Fax:
Practice Address - Street 1:188 WALTERS CREEK DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7941
Practice Address - Country:US
Practice Address - Phone:509-230-8979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0001739-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily