Basic Information
| Provider Information | |||||||||
| NPI: | 1477223576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8881 FLETCHER PARKWAY | ||||||||
| Address2: | ST. 200 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919425705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194646434 | ||||||||
| FaxNumber: | 7608277225 | ||||||||
| Practice Location | |||||||||
| Address1: | 8881 FLETCHER PARKWAY | ||||||||
| Address2: | ST. 200 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919425705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194646434 | ||||||||
| FaxNumber: | 7608277225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2021 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | NP95017921 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 95112294 | 01 | CA | CALIFORNIA BOARD OF REGISTERED NURSING | OTHER | NP95017921 | 01 | CA | CALIFORNIA BOARD OF REGISTERED NURSING | OTHER |