Healthcare Provider Details

I. General information

NPI: 1255067856
Provider Name (Legal Business Name): KIERSTYN GATES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIERSTYN POLTE

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W JANSS RD
THOUSAND OAKS CA
91360-1847
US

IV. Provider business mailing address

215 W JANSS RD
THOUSAND OAKS CA
91360-1847
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberNP95020755
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95020755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: