=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598554305
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN SWEENEY PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2025
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1172 E GRAND AVE
-----------------------------------------------------
City | ARROYO GRANDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93420-2556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-210-0472
-----------------------------------------------------
Fax | 877-399-5883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1130 E CLARK AVE STE 150-124
-----------------------------------------------------
City | ORCUTT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93455-5178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 95034913
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------