Provider Demographics
NPI:1497197594
Name:KLADAR, KATHY KAREN (FNP-BC)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:KAREN
Last Name:KLADAR
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3786
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-3786
Mailing Address - Country:US
Mailing Address - Phone:928-575-7552
Mailing Address - Fax:888-355-4604
Practice Address - Street 1:1306 SOUTH CALIFORNIA AVENUE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344
Practice Address - Country:US
Practice Address - Phone:928-575-7552
Practice Address - Fax:888-355-4604
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23302363LF0000X, 363LF0000X
AZ291148363LP2300X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013012247OtherAMERICAN NURSE CREDENTIALING CENTER FAMILY NURSE PRACTITIONER, BOARD CERTIFIED