Healthcare Provider Details

I. General information

NPI: 1477223576
Provider Name (Legal Business Name): KATHERINE WARD APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 FLETCHER PKWY STE 205
LA MESA CA
91942-3187
US

IV. Provider business mailing address

8881 FLETCHER PKWY STE 205
LA MESA CA
91942-3187
US

V. Phone/Fax

Practice location:
  • Phone: 619-464-6434
  • Fax: 619-464-5109
Mailing address:
  • Phone: 619-464-6434
  • Fax: 619-464-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95017921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: