MEDICARE: KATHLEEN M DUTTON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN322802	AZ
2	363L00000X	Nurse Practitioner	15665	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15665	OTHER	CA	FNP
2	434015	OTHER	CA	RN

General Provider Information

NPI Number	:	1851466890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M DUTTON FNP

Provider Business Mailing Address
First Line	:	514 CHABLIS DR
Second Line	:
City	:	WINDSOR
State	:	CA
Zip	:	95492-6691
Country	:	US
Telephone Number	:	707-620-0014
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 CIRCADIAN WAY
Second Line	:	SUITE A
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-5444
Country	:	US
Telephone Number	:	707-526-2027
Fax Number	:	707-526-2096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	10/10/2025

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