Healthcare Provider Details

I. General information

NPI: 1528155496
Provider Name (Legal Business Name): KAYCEE LEANN KAHLER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYCEE LEANN HOLGUIN PAC

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 COLORADO AVE
TURLOCK CA
95382-2706
US

IV. Provider business mailing address

4580 ARENA WAY
ATWATER CA
95301-9312
US

V. Phone/Fax

Practice location:
  • Phone: 209-216-3300
  • Fax: 209-216-3301
Mailing address:
  • Phone: 209-535-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: