Healthcare Provider Details

I. General information

NPI: 1336071331
Provider Name (Legal Business Name): KAILEY MAE PARKER RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 HELEN WAY
BAKERSFIELD CA
93307-6112
US

IV. Provider business mailing address

6610 BETTY ST
BAKERSFIELD CA
93307-5604
US

V. Phone/Fax

Practice location:
  • Phone: 661-832-3098
  • Fax:
Mailing address:
  • Phone: 661-529-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1598570225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: