MEDICARE: DR. KATHRYN HUGHLOCK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	95011160	CA

General Provider Information

NPI Number	:	1568864858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN HUGHLOCK NP

Provider Business Mailing Address
First Line	:	6537 REFLECTION DR APT 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-3195
Country	:	US
Telephone Number	:	206-851-5121
Fax Number	:

Provider Business Practice Location Address
First Line	:	7525 LINDA VISTA RD STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5344
Country	:	US
Telephone Number	:	858-277-2361
Fax Number	:	858-569-1981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	08/11/2025

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