Healthcare Provider Details

I. General information

NPI: 1497114672
Provider Name (Legal Business Name): KAYLA PATEL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 EMPIRE ST STE 120
FAIRFIELD CA
94533-5550
US

IV. Provider business mailing address

1005 ATLANTIC AVE
ALAMEDA CA
94501-1148
US

V. Phone/Fax

Practice location:
  • Phone: 707-440-9923
  • Fax:
Mailing address:
  • Phone: 415-474-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95068942
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95015382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: