Healthcare Provider Details

I. General information

NPI: 1124170154
Provider Name (Legal Business Name): KATHLEEN ANN WINFREY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SANTA FE DR STE 200
ENCINITAS CA
92024-5137
US

IV. Provider business mailing address

3200 E CAMELBACK RD STE 250
PHOENIX AZ
85018-2327
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax: 858-467-7161
Mailing address:
  • Phone: 602-933-1814
  • Fax: 602-933-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number19718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: