KATHLEEN MARIE FENNELLY (NPI# 1649262429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649262429 |
| Entity Type | Individual |
| Full Name | KATHLEEN MARIE FENNELLY |
| Credential | R.N., N.P, |
| Practice Address |
896 E Foothill Blvd San Luis Obispo CA 93405-1761 |
| Practice Telephone | 8055420900 |
| Mailing Telephone | 8055420900 |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2009-08-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LX0001X |
Nurse Practitioner Specialization: Obstetrics & Gynecology |
7319 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | NP LICENSE # | 7319 | 01 |
| CA | RN LICENSE # | 456414 | 01 |
| Street Address |
896 E FOOTHILL BLVD |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip Code | 93405-1761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164076626 | Hilary Abbott Anderson | Physician Assistant | 127 Casa St., San Luis Obispo, CA 93405 | 2019-08-01 |
| 1811465834 | Fatemeh Ladan Ahmadinia | Dentist | 764 N Santa Rosa St, San Luis Obispo, CA 93405 | 2018-11-07 |
| 1538559794 | Arnold Martin Horwitz | Marriage & Family Therapist | 1605 Garnette Drive, San Luis Obispo, CA 93405 | 2015-01-27 |
| 1750794764 | Solmaz Naghsh | Pharmacist | 765 Foothill Blvd, San Luis Obispo, CA 93405 | 2014-06-06 |
| 1609293471 | Robert S. Flores Dmd, Inc | Dentist | 878 Boysen Avenue, San Luis Obispo, CA 93405 | 2014-03-18 |
| 1457776445 | Laura Anne Wilvert | Marriage & Family Therapist | 793 E. Foothill Blvd, Suite A, #278, San Luis Obispo, CA 93405 | 2014-02-27 |
| 1497181200 | Tracey Ruby Madrigal | Counselor | 1106 Oceanaire Dr. #25, San Luis Obispo, CA 93405 | 2013-09-25 |
| 1437597572 | Sarah Michelle Brenis | Counselor | 524 Princeton Place, San Luis Obispo, CA 93405 | 2013-06-11 |
| 1013350974 | Jenna Rose Ramos | Counselor | 1459 Descanso St., San Luis Obispo, CA 93405 | 2013-04-10 |
| 1700140696 | Christopher Dieterich Marchand | Social Worker | 793a E. Foothill Blvd, 190, San Luis Obispo, CA 93405 | 2012-06-26 |
| Find all providers in zip 93405 | ||||
| Taxonomy Code | 363LX0001X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Obstetrics & Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770726010 | Alexandra S Santos | Nurse Practitioner | 184 Casa St, San Luis Obispo, CA 93405-1804 | 2009-04-16 |
| 1659594182 | Christine Clickard | Nurse Practitioner | 184 Casa St, San Luis Obispo, CA 93405-1804 | 2007-04-11 |
| 1235150921 | Melody Kopisch | Nurse Practitioner | 100 Casa St, Suite B, San Luis Obispo, CA 93405-1883 | 2006-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548819964 | Myra Sepulveda | Nurse Practitioner | 1700 Lombard St Ste 110, Oxnard, CA 93030-8288 | 2019-09-09 |
| 1639641699 | Zahra Jeylani Nur | Nurse Practitioner | 15101 Spectrum, Irvine, CA 92618-3426 | 2018-12-31 |
| 1518486125 | Patty Montoya | Nurse Practitioner | 1026 Felder St, Gardena, CA 90248-3348 | 2017-09-14 |
| 1902357817 | Alexandria Ludlow | Nurse Practitioner | 350 John Muir Pkwy Ste 205, Brentwood, CA 94513-5193 | 2016-10-17 |
| 1477922102 | Vanessa Domush | Nurse Practitioner | 845 E. Willow St, Signal Hill, CA 90755 | 2015-09-23 |
| 1174999015 | Kristina Hagopian | Nurse Practitioner | 8920 Wilshire Blvd Ste 525, Beverly Hills, CA 90211-1968 | 2015-08-14 |
| 1639553076 | Pacific Women's Healthcare Associates | Nurse Practitioner | 500 Superior Ave Ste 310, Newport Beach, CA 92663-3609 | 2015-07-15 |
| 1548655921 | Trudi J Petersen | Nurse Practitioner | 1700 Shattuck Ave # 75, Berkeley, CA 94709-3402 | 2015-04-01 |
| 1932590775 | Samah Shahzya Kureshi | Nurse Practitioner | 2619 Vanderbilt Ln Unit B, Redondo Beach, CA 90278-3318 | 2015-02-16 |
| 1346645801 | Norma Nix | Nurse Practitioner | 22423 Chase St, West Hills, CA 91304-3321 | 2014-10-27 |
| Find all providers with the same taxonomy | ||||
| City | SAN LUIS OBISPO |
| Zip Code | 93405 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.