Provider Demographics
NPI:1023764891
Name:PAPE, KATHLEEN ANN MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN MARIE
Last Name:PAPE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 MEADOW LN APT 17
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-3718
Mailing Address - Country:US
Mailing Address - Phone:970-596-5001
Mailing Address - Fax:
Practice Address - Street 1:1160 MEADOW LN APT 17
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-3718
Practice Address - Country:US
Practice Address - Phone:970-596-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95215579163W00000X
CA95020164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse