Provider Demographics
NPI:1770958175
Name:BEHRENDT, KALEIGH MARIE (RN, PHN)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:MARIE
Last Name:BEHRENDT
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:KALEIGH
Other - Middle Name:MARIE
Other - Last Name:MCCLINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:3851 ROSECRANS ST
Mailing Address - Street 2:SUITE Y15
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-692-8435
Mailing Address - Fax:858-715-6458
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:SUITE Y15
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8435
Practice Address - Fax:858-715-6458
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA847500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse