Healthcare Provider Details

I. General information

NPI: 1538987938
Provider Name (Legal Business Name): JASPREET KAUR THIARA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 N MEDICAL CENTER DR E STE 205
CLOVIS CA
93611-6886
US

IV. Provider business mailing address

6691 W MORRIS AVE
FRESNO CA
93723-8119
US

V. Phone/Fax

Practice location:
  • Phone: 559-900-3045
  • Fax:
Mailing address:
  • Phone: 559-349-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: