MEDICARE: GLORIA LEE KENT RN,CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	226867/12812	CA

General Provider Information

NPI Number	:	1134117963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA LEE KENT RN,CNP

Provider Business Mailing Address
First Line	:	10470 OLD PLACERVILLE RD
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2539
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MISSION BOULEVARD
Second Line	:	SUITE 2800
City	:	JACKSON
State	:	CA
Zip	:	95642-2147
Country	:	US
Telephone Number	:	209-257-0177
Fax Number	:	209-257-0176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/27/2015

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