Healthcare Provider Details

I. General information

NPI: 1982560660
Provider Name (Legal Business Name): RAREFORM MENTAL HEALTH NURSING APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 CABRILLO WAY
ROCKLIN CA
95765-5148
US

IV. Provider business mailing address

785 ORCHARD DR STE 250
FOLSOM CA
95630-5547
US

V. Phone/Fax

Practice location:
  • Phone: 916-258-2199
  • Fax:
Mailing address:
  • Phone: 916-258-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIZZY MYISHA PARKER
Title or Position: CEO/PMHNP
Credential: PMHNP
Phone: 916-258-2199