Provider Demographics
NPI:1720121239
Name:BATTERSBY, KATHLEEN (CPNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BATTERSBY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5724
Mailing Address - Country:US
Mailing Address - Phone:310-821-8600
Mailing Address - Fax:
Practice Address - Street 1:1801 E MARENGO ST
Practice Address - Street 2:ROOM 1G1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1365
Practice Address - Country:US
Practice Address - Phone:323-226-3813
Practice Address - Fax:323-226-5049
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283243363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics