Healthcare Provider Details

I. General information

NPI: 1033734900
Provider Name (Legal Business Name): KIMBERLY A ELLIOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY BROWN NP

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SIERRA COLLEGE DR STE 120
GRASS VALLEY CA
95945-5088
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-8358
  • Fax: 530-477-2015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: