Healthcare Provider Details

I. General information

NPI: 1295533701
Provider Name (Legal Business Name): KYLIE ELIZABETH O'CONNOR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 CANEHILL AVE
LONG BEACH CA
90815-2259
US

IV. Provider business mailing address

2345 CANEHILL AVE
LONG BEACH CA
90815-2259
US

V. Phone/Fax

Practice location:
  • Phone: 917-446-4345
  • Fax:
Mailing address:
  • Phone: 917-446-4345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95033280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: