Healthcare Provider Details

I. General information

NPI: 1144577347
Provider Name (Legal Business Name): KAREN CHESTNUT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N ROSE AVE
OXNARD CA
93030-3722
US

IV. Provider business mailing address

537 JEFFREY DR
SAN LUIS OBISPO CA
93405-1003
US

V. Phone/Fax

Practice location:
  • Phone: 805-550-4478
  • Fax:
Mailing address:
  • Phone: 805-550-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: