Provider Demographics
NPI:1013060144
Name:KINRADE, KATHLEEN ALICE (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALICE
Last Name:KINRADE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 SEBREN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-3036
Mailing Address - Country:US
Mailing Address - Phone:562-421-7581
Mailing Address - Fax:
Practice Address - Street 1:9200 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5805
Practice Address - Country:US
Practice Address - Phone:714-484-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469155363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner