Provider Demographics
NPI:1952885899
Name:BANKERD, KATHLEEN M (CA HOME CARE AIDE)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:BANKERD
Suffix:
Gender:F
Credentials:CA HOME CARE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2192 S COAST HWY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6536
Mailing Address - Country:US
Mailing Address - Phone:760-672-9443
Mailing Address - Fax:
Practice Address - Street 1:2192 S COAST HWY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6536
Practice Address - Country:US
Practice Address - Phone:760-672-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7517245226374U00000X, 372500000X, 253Z00000X, 376J00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care