=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184409716
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAYATRI GAUTAM FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2023
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 W KERN AVE
-----------------------------------------------------
City | MC FARLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93250-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-792-3038
-----------------------------------------------------
Fax | 661-792-6270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 217 W KERN AVE
-----------------------------------------------------
City | MC FARLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93250-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-792-3038
-----------------------------------------------------
Fax | 661-792-6270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95025877
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------