Basic Information
| Provider Information | |||||||||
| NPI: | 1306360656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERDES | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | VALERIE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 GOLDEN GATE BLVD W | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341203043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396014659 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7385 RADIO RD STE 104 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341046705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393849392 | ||||||||
| FaxNumber: | 2392947252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2017 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | ARNP9366351 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.