Healthcare Provider Details

I. General information

NPI: 1376282178
Provider Name (Legal Business Name): KELLEIGH SORENSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 BUENA VISTA DR STE 201
PASO ROBLES CA
93446-8581
US

IV. Provider business mailing address

2727 BUENA VISTA DR STE 201
PASO ROBLES CA
93446-8581
US

V. Phone/Fax

Practice location:
  • Phone: 805-395-3277
  • Fax:
Mailing address:
  • Phone: 805-395-3277
  • Fax: 805-591-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021825
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number659914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: