Healthcare Provider Details

I. General information

NPI: 1821705112
Provider Name (Legal Business Name): KATHRYN DELISO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN ELKINS

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 ALTURAS DR
BAKERSFIELD CA
93305-2406
US

IV. Provider business mailing address

2625 ALTURAS DR
BAKERSFIELD CA
93305-2406
US

V. Phone/Fax

Practice location:
  • Phone: 661-910-5601
  • Fax:
Mailing address:
  • Phone: 661-910-5601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000000000
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number845175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: