Healthcare Provider Details

I. General information

NPI: 1881555472
Provider Name (Legal Business Name): KATHLEEN RAE COLVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 N VILLA AVE
WILLOWS CA
95988-2607
US

IV. Provider business mailing address

2710 GATEWAY OAKS DR
SACRAMENTO CA
95833-3505
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-8700
  • Fax:
Mailing address:
  • Phone: 916-646-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95039019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: