Healthcare Provider Details

I. General information

NPI: 1851466890
Provider Name (Legal Business Name): KATHLEEN M DUTTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 CIRCADIAN WAY SUITE A
SANTA ROSA CA
95407-5444
US

IV. Provider business mailing address

514 CHABLIS DR
WINDSOR CA
95492-6691
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-2027
  • Fax: 707-526-2096
Mailing address:
  • Phone: 707-620-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15665
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN322802
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: