Healthcare Provider Details

I. General information

NPI: 1902202807
Provider Name (Legal Business Name): JAMIE KUTTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 VICTOR AVE
REDDING CA
96003-4031
US

IV. Provider business mailing address

3340 PIPER WAY
REDDING CA
96001-2324
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-9273
  • Fax:
Mailing address:
  • Phone: 801-618-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: