Healthcare Provider Details

I. General information

NPI: 1790679207
Provider Name (Legal Business Name): KIRSTEN ANNE BARTRA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 JOSHUA AVE
CLOVIS CA
93611-6054
US

IV. Provider business mailing address

3214 JOSHUA AVE
CLOVIS CA
93611-6054
US

V. Phone/Fax

Practice location:
  • Phone: 559-612-3469
  • Fax:
Mailing address:
  • Phone: 559-612-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: