Healthcare Provider Details

I. General information

NPI: 1326024688
Provider Name (Legal Business Name): BETH A GERKAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 STATE HIGHWAY 193
GEORGETOWN CA
95634-9623
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-333-2555
  • Fax: 503-333-8232
Mailing address:
  • Phone: 530-333-2555
  • Fax: 503-333-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number417801
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberNP11335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: