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General NPI Number Information
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NPI Number | 1982560660
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Entity Type | Organization
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Legal Business Name | RAREFORM MENTAL HEALTH NURSING APC
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Dates
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Enumeration Date | 12/26/2025
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 5517 CABRILLO WAY
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City | ROCKLIN
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State | CA
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Zip | 95765-5148
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Country | US
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Telephone | 916-258-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 785 ORCHARD DR STE 250
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City | FOLSOM
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State | CA
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Zip | 95630-5547
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Country | US
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Telephone | 916-258-2199
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Fax |
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Authorized Official
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Title or Position | CEO/PMHNP
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Name | KIZZY MYISHA PARKER
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Credential | PMHNP
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Telephone | 916-258-2199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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