1962788034 NPI number — DR. KATHLEEN CONDRY HARLEY N.D.

Table of content: BILLY C NOBLE CADC (NPI 1154422202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962788034 NPI number — DR. KATHLEEN CONDRY HARLEY N.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARLEY
Provider First Name:
KATHLEEN
Provider Middle Name:
CONDRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARLEY
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
CONDRY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ND
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962788034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8669 SALMON AVE UNIT 2705
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGS BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96143-8108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-721-7453
Provider Business Mailing Address Fax Number:
415-721-7454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 BEL MARIN KEYS BLVD STE D2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVATO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94949-5709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-721-7453
Provider Business Practice Location Address Fax Number:
415-721-7454
Provider Enumeration Date:
11/02/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ND-481 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 405300000X , with the licence number: ND-481 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , with the licence number: ND-481 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)