Healthcare Provider Details

I. General information

NPI: 1366319063
Provider Name (Legal Business Name): KRISTEN NOEL PANOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 CUMMINS DR STE B
MODESTO CA
95358-6402
US

IV. Provider business mailing address

1581 CUMMINS DR STE B
MODESTO CA
95358-6402
US

V. Phone/Fax

Practice location:
  • Phone: 209-492-4118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: