Provider Demographics
NPI:1962788034
Name:HARLEY, KATHLEEN CONDRY (ND)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:CONDRY
Last Name:HARLEY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:CONDRY
Other - Last Name:HARLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:8669 SALMON AVE UNIT 2705
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143-8108
Mailing Address - Country:US
Mailing Address - Phone:415-721-7453
Mailing Address - Fax:415-721-7454
Practice Address - Street 1:250 BEL MARIN KEYS BLVD STE D2
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5709
Practice Address - Country:US
Practice Address - Phone:415-721-7453
Practice Address - Fax:415-721-7454
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-481207Q00000X, 405300000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No405300000XOther Service ProvidersPrevention Professional