Provider Demographics
NPI:1952845596
Name:O'MALLEY, KATHRYN MAHONEY (RN FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MAHONEY
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0425
Mailing Address - Country:US
Mailing Address - Phone:707-476-4981
Mailing Address - Fax:707-476-4998
Practice Address - Street 1:317 2ND ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0425
Practice Address - Country:US
Practice Address - Phone:707-476-4981
Practice Address - Fax:707-476-4998
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389678163WP2201X, 364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care