Healthcare Provider Details

I. General information

NPI: 1962057281
Provider Name (Legal Business Name): KYLE DAVID JASPER PMHNP, MSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8421 AUBURN BLVD # 162
CITRUS HEIGHTS CA
95610-0359
US

IV. Provider business mailing address

3780 ROSIN CT STE 110
SACRAMENTO CA
95834-1698
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-3819
  • Fax: 916-441-6377
Mailing address:
  • Phone: 916-441-0226
  • Fax: 916-441-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95015599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: