Healthcare Provider Details

I. General information

NPI: 1942225156
Provider Name (Legal Business Name): KAMEREN JOY OWENS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 LOMBARDI CT
SANTA ROSA CA
95407-6798
US

IV. Provider business mailing address

3569 ROUND BARN CIR STE 203
SANTA ROSA CA
95403-5781
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-3600
  • Fax:
Mailing address:
  • Phone: 707-303-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN000879
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1744
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15943
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number15943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: