Healthcare Provider Details

I. General information

NPI: 1326671124
Provider Name (Legal Business Name): KATHRINE ANNE HERNANDEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N HOLLYWOOD WAY
BURBANK CA
91505-3406
US

IV. Provider business mailing address

511 N HOLLYWOOD WAY
BURBANK CA
91505-3406
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-0710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number728464
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: