Healthcare Provider Details

I. General information

NPI: 1568864858
Provider Name (Legal Business Name): KATHRYN HUGHLOCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 LINDA VISTA RD STE A
SAN DIEGO CA
92111-5344
US

IV. Provider business mailing address

6537 REFLECTION DR APT 210
SAN DIEGO CA
92124-3195
US

V. Phone/Fax

Practice location:
  • Phone: 858-277-2361
  • Fax: 858-569-1981
Mailing address:
  • Phone: 206-851-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95011160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: