Healthcare Provider Details

I. General information

NPI: 1679867154
Provider Name (Legal Business Name): KAYTASHA MARIE PEMPLETON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYTASHA MARIE BERT RN

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 HALL RD
LAMONT CA
93241-1953
US

IV. Provider business mailing address

11512 OCEAN WAVE DR
BAKERSFIELD CA
93312-8228
US

V. Phone/Fax

Practice location:
  • Phone: 661-845-3731
  • Fax:
Mailing address:
  • Phone: 661-588-7863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: