Healthcare Provider Details

I. General information

NPI: 1962788034
Provider Name (Legal Business Name): KATHLEEN CONDRY HARLEY N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN CONDRY HARLEY ND

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 02/12/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BEL MARIN KEYS BLVD STE D2
NOVATO CA
94949-5709
US

IV. Provider business mailing address

8669 SALMON AVE UNIT 2705
KINGS BEACH CA
96143-8108
US

V. Phone/Fax

Practice location:
  • Phone: 415-721-7453
  • Fax: 415-721-7454
Mailing address:
  • Phone: 415-721-7453
  • Fax: 415-721-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberND-481
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberND-481
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: