Provider Demographics
NPI:1184691248
Name:WERNER, KATHLEEN DONLEAVY (MS APRN BC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DONLEAVY
Last Name:WERNER
Suffix:
Gender:F
Credentials:MS APRN BC
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:DONLEAVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA APRN BC
Mailing Address - Street 1:7050 LONE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-8876
Mailing Address - Country:US
Mailing Address - Phone:631-871-2636
Mailing Address - Fax:
Practice Address - Street 1:7050 LONE OAK BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-8876
Practice Address - Country:US
Practice Address - Phone:631-871-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302537363LA2200X
FL9349315363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01908956Medicaid
FL019738800Medicaid
FL91N881Medicare PIN
S88318Medicare UPIN
FL019738800Medicaid