Provider Demographics
NPI:1366985988
Name:LI, KATHARINE GILLY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:GILLY
Last Name:LI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CRECIENTA DR
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1806
Mailing Address - Country:US
Mailing Address - Phone:504-952-0111
Mailing Address - Fax:
Practice Address - Street 1:2 CRECIENTA DR
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1806
Practice Address - Country:US
Practice Address - Phone:504-952-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN131730163WG0000X
LAAP09236363LF0000X
NY341656363LF0000X
CA95022284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice