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General NPI Number Information
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NPI Number | 1821754979
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Entity Type | Individual
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Provider Name | KAITLYN ELIZABETH FAKOURI FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 3441 MARYSVILLE BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95838-4512
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Country | US
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Telephone | 916-737-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 11776 PLATO WAY
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City | RANCHO CORDOVA
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State | CA
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Zip | 95742-8107
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Country | US
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Telephone | 225-333-0806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95019130
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License Number State | CA
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