Healthcare Provider Details

I. General information

NPI: 1851226005
Provider Name (Legal Business Name): JANELLA KIRKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST STE 201
GRASS VALLEY CA
95945-5853
US

IV. Provider business mailing address

16030 BREWER RD
GRASS VALLEY CA
95949-7001
US

V. Phone/Fax

Practice location:
  • Phone: 916-519-9050
  • Fax: 916-519-9050
Mailing address:
  • Phone: 916-519-9050
  • Fax: 916-519-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: