Healthcare Provider Details

I. General information

NPI: 1982496741
Provider Name (Legal Business Name): KATHRYN LEE FLUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREENLEY RD
SONORA CA
95370-5200
US

IV. Provider business mailing address

10824 ROBINWOOD LN
SONORA CA
95370-9225
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-5000
  • Fax:
Mailing address:
  • Phone: 209-743-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number813368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: