Provider Demographics
NPI:1952326779
Name:FLARITY, KATHLEEN (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FLARITY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W. ENT AVE
Mailing Address - Street 2:ATTN: 21 MDOS/SGOF-FAM HLTH, 302D/CC
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-1133
Mailing Address - Fax:866-867-7926
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:ATTN: 21 MDOS/SGOF-FAMILY PRACTICE, 302D/CC
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80914-1541
Practice Address - Country:US
Practice Address - Phone:719-556-1133
Practice Address - Fax:866-867-7926
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004200363L00000X
CONP10177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151494OtherL&I
WA9619982Medicaid
WAAB23741Medicare ID - Type Unspecified
WA9619982Medicaid