Healthcare Provider Details

I. General information

NPI: 1346998945
Provider Name (Legal Business Name): KYLIE LAWSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 03/13/2022
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 N MEDICAL CENTER DR E STE 221
CLOVIS CA
93611-6886
US

IV. Provider business mailing address

402 W CHENNAULT AVE
CLOVIS CA
93611-6720
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-2900
  • Fax:
Mailing address:
  • Phone: 559-284-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: