Provider Demographics
NPI:1366512626
Name:HEALEY, KATHLEEN M (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:HEALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2900
Mailing Address - Country:US
Mailing Address - Phone:707-251-3608
Mailing Address - Fax:707-251-1727
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 210
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2900
Practice Address - Country:US
Practice Address - Phone:707-251-3608
Practice Address - Fax:707-251-1727
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG49386207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G493860Medicaid
CA00G493860Medicare ID - Type Unspecified
CA00G493860Medicaid
CAEH503YMedicare PIN