Provider Demographics
NPI:1396950135
Name:JAMES, KATHY SHADLE (DNSC, NP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:SHADLE
Last Name:JAMES
Suffix:
Gender:F
Credentials:DNSC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 SERPENTINE DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2442
Mailing Address - Country:US
Mailing Address - Phone:619-890-1244
Mailing Address - Fax:858-259-9375
Practice Address - Street 1:1933 CABLE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2807
Practice Address - Country:US
Practice Address - Phone:619-221-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily