Healthcare Provider Details

I. General information

NPI: 1134117963
Provider Name (Legal Business Name): GLORIA LEE KENT RN,CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MISSION BOULEVARD SUITE 2800
JACKSON CA
95642-2147
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-0177
  • Fax: 209-257-0176
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number226867/12812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: