Healthcare Provider Details

I. General information

NPI: 1841070463
Provider Name (Legal Business Name): CHLOE R KIESTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11620 WILSHIRE BLVD STE 520
LOS ANGELES CA
90025-1778
US

IV. Provider business mailing address

3061 FILLMORE ST
SAN FRANCISCO CA
94123-4009
US

V. Phone/Fax

Practice location:
  • Phone: 310-601-5099
  • Fax:
Mailing address:
  • Phone: 310-601-5099
  • Fax: 888-988-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95027327
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95027327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: