Healthcare Provider Details

I. General information

NPI: 1013612753
Provider Name (Legal Business Name): CATHERINE NYQUIST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE KEANE PA-C

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TOWN CENTER BLVD BLDG D
EL DORADO HILLS CA
95762-7100
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-344-2070
  • Fax: 530-748-0332
Mailing address:
  • Phone: 530-626-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: