Healthcare Provider Details

I. General information

NPI: 1396672895
Provider Name (Legal Business Name): KRISTINA WOMACK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 LAS TABLAS RD STE 101
TEMPLETON CA
93465-9746
US

IV. Provider business mailing address

PO BOX 632
SANTA MARGARITA CA
93453-0632
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-3473
  • Fax:
Mailing address:
  • Phone: 559-288-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95107613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: