Provider Demographics
NPI:1285086702
Name:CONOVER, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CONOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:CONOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3020 CHILDREN'S WAY, MC 5018
Mailing Address - Street 2:RADY CHILDREN'S OUTPATIENT PSYCHIATRY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:919-360-0643
Mailing Address - Fax:858-966-6733
Practice Address - Street 1:3020 CHILDRENS WAY # MC5018
Practice Address - Street 2:RADY CHILDREN'S OUTPATIENT PSYCHIATRY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:919-360-0643
Practice Address - Fax:858-966-6733
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program