Mary Kay Klockmann
Nurse Practitioner
608 G Street Brawley
Brawley
, California 92227-2567
Mary Kay Klockmann
Nurse Practitioner
608 G Street Brawley
Brawley
, California 92227-2567
(760) 355-7731
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About
Features
Specialties
- Nurse Practitioner
Languages spoken
- English
Location
First Address
- Mary Kay Klockmann
- 516 W Aten Rd Imperial
- Imperial, CA
- Zip : 92251-9805
- Fax : (760) 355-7731
- Phone : (760) 355-7730
Second Address
- Mary Kay Klockmann
- 608 G Street Brawley
- Brawley, CA
- Zip : 92227-2567
- Fax : (760) 545-0247
- Phone : (760) 351-1011
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | RN402384 | CA |
National Provider Identifier
| NPI | 1003840174 |
|---|---|
| Provider Name | Mary Kay Klockmann |
| First Address | Imperial, CA 92251-9805 |
| Second Address | Brawley, CA 92227-2567 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 11/07/2006 |
| Last Update Date | 08/05/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| P21747 | (02) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.