Healthcare Provider Details

I. General information

NPI: 1710640313
Provider Name (Legal Business Name): JEFFERSON PATRICK HUOT MSN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 CHESTER AVE
BAKERSFIELD CA
93301-2014
US

IV. Provider business mailing address

11121 TRENTADUE DR
BAKERSFIELD CA
93312-6733
US

V. Phone/Fax

Practice location:
  • Phone: 661-863-3260
  • Fax:
Mailing address:
  • Phone: 661-865-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95021236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: