Healthcare Provider Details

I. General information

NPI: 1508494097
Provider Name (Legal Business Name): FAYANNE KIRKPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 MIRANDY DR
SACRAMENTO CA
95826-5224
US

IV. Provider business mailing address

8748 KENTSHIRE WAY
SACRAMENTO CA
95828-6173
US

V. Phone/Fax

Practice location:
  • Phone: 916-395-5310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: