Healthcare Provider Details

I. General information

NPI: 1477174399
Provider Name (Legal Business Name): KIRSTEN KUHN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 SILVERADO ST STE 203
LA JOLLA CA
92037-4524
US

IV. Provider business mailing address

2644 POLK AVE
SAN DIEGO CA
92104-1709
US

V. Phone/Fax

Practice location:
  • Phone: 858-412-5141
  • Fax:
Mailing address:
  • Phone: 619-846-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95014479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: