Provider Demographics
NPI:1912001629
Name:KENT, KATHARINE ALEXANDER (CNM)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:ALEXANDER
Last Name:KENT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:KENT
Other - Last Name:OTERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-524-6195
Mailing Address - Fax:619-524-6191
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-524-6195
Practice Address - Fax:619-524-6191
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236187367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95225529OtherRN LICENSE