Basic Information
| Provider Information | |||||||||
| NPI: | 1952326779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLARITY | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 W. ENT AVE | ||||||||
| Address2: | ATTN: 21 MDOS/SGOF-FAM HLTH, 302D/CC | ||||||||
| City: | PETERSON AFB | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809141540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195561133 | ||||||||
| FaxNumber: | 8668677926 | ||||||||
| Practice Location | |||||||||
| Address1: | 559 VINCENT ST | ||||||||
| Address2: | ATTN: 21 MDOS/SGOF-FAMILY PRACTICE, 302D/CC | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809141541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195561133 | ||||||||
| FaxNumber: | 8668677926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 04/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP30004200 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | NP10177 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0151494 | 01 | WA | L&I | OTHER | 9619982 | 05 | WA | MEDICAID |