Healthcare Provider Details

I. General information

NPI: 1649835471
Provider Name (Legal Business Name): STARR S GAINES-GLYNN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5464 N PALM AVE STE A
FRESNO CA
93704-1946
US

IV. Provider business mailing address

6638 W RIALTO AVE
FRESNO CA
93723-9463
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-3438
  • Fax:
Mailing address:
  • Phone: 559-270-1898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number950004595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: