Healthcare Provider Details

I. General information

NPI: 1144539222
Provider Name (Legal Business Name): TERRA LEE WILSON-KAYSSER CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 MAUREEN LN
PLEASANT HILL CA
94523-2142
US

IV. Provider business mailing address

517 MAUREEN LN
PLEASANT HILL CA
94523-2142
US

V. Phone/Fax

Practice location:
  • Phone: 925-798-9696
  • Fax:
Mailing address:
  • Phone: 925-798-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number16927
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number261469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: