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General NPI Number Information
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NPI Number | 1942574488
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Entity Type | Individual
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Provider Name | KIMBERLY ANN ORTA NP
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Gender | Female
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 824 PINE ST
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-2137
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Country | US
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Telephone | 530-926-4528
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Fax |
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Provider Business Mailing Address
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Address Line | 116 W MINNESOTA AVE
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City | MCCLOUD
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State | CA
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Zip | 96057-0601
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Country | US
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Telephone | 530-964-2389
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Fax | 530-964-3141
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 604263
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201705838NP-PP
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95007009
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License Number State | CA
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