Healthcare Provider Details

I. General information

NPI: 1265497630
Provider Name (Legal Business Name): KIRSTEN C DUGGINS P.A., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 BROOKE ACRES DR
LOS GATOS CA
95032-6462
US

IV. Provider business mailing address

221 BROOKE ACRES DR
LOS GATOS CA
95032-6462
US

V. Phone/Fax

Practice location:
  • Phone: 408-656-9049
  • Fax:
Mailing address:
  • Phone: 408-656-9049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 12256
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number257522-4568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: