Healthcare Provider Details

I. General information

NPI: 1962293183
Provider Name (Legal Business Name): KATIE ELIZABETH KAKOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NAPA VALLEY CORPORATE DR
NAPA CA
94558-6216
US

IV. Provider business mailing address

515 MCKENZIE DR
DIXON CA
95620-2329
US

V. Phone/Fax

Practice location:
  • Phone: 707-253-6172
  • Fax:
Mailing address:
  • Phone: 707-761-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95184524
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: