Healthcare Provider Details

I. General information

NPI: 1952740839
Provider Name (Legal Business Name): KRISTY DIANE RACKLIFFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 MCCOURTNEY RD
GRASS VALLEY CA
95949-7400
US

IV. Provider business mailing address

988 MCCOURTNEY RD
GRASS VALLEY CA
95949-7400
US

V. Phone/Fax

Practice location:
  • Phone: 510-482-2244
  • Fax: 510-530-2047
Mailing address:
  • Phone: 510-482-2244
  • Fax: 510-530-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: