Healthcare Provider Details

I. General information

NPI: 1275271918
Provider Name (Legal Business Name): KRISTIN EASLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9653 FOLSOM BLVD
SACRAMENTO CA
95827-1212
US

IV. Provider business mailing address

PO BOX 581961
ELK GROVE CA
95758-0033
US

V. Phone/Fax

Practice location:
  • Phone: 916-899-7787
  • Fax:
Mailing address:
  • Phone: 916-899-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number821605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: