Healthcare Provider Details

I. General information

NPI: 1417872888
Provider Name (Legal Business Name): SUPREET KAUR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 TILDEN ST
MANTECA CA
95337-7822
US

IV. Provider business mailing address

759 TILDEN ST
MANTECA CA
95337-7822
US

V. Phone/Fax

Practice location:
  • Phone: 510-509-4059
  • Fax:
Mailing address:
  • Phone: 510-509-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: