Healthcare Provider Details

I. General information

NPI: 1932029337
Provider Name (Legal Business Name): MRS. KAYLI HIRSTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 GOLDEN CENTER DR STE A
PLACERVILLE CA
95667-6260
US

IV. Provider business mailing address

4061 MEADOW WOOD DR
EL DORADO HILLS CA
95762-7513
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-1144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number202530350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: