Healthcare Provider Details

I. General information

NPI: 1053817841
Provider Name (Legal Business Name): KAITLYN BRIGGS SPEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MEDICAL PLAZA DR STE 260
ROSEVILLE CA
95661-3089
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-7877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA164687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: