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NPI Code Detail

MEDICARE: KAITLYN ELIZABETH FAKOURI FNP-C

MEDICARE: KAITLYN ELIZABETH FAKOURI FNP-C
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
1363L00000XNurse Practitioner95019130CA

General Provider Information

NPI Number : 1821754979
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN ELIZABETH FAKOURI FNP-C
Provider Business Mailing Address
First Line : PO BOX 761
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95741-0761
Country : US
Telephone Number : 225-333-0806
Fax Number :
Provider Business Practice Location Address
First Line : 3441 MARYSVILLE BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95838-4512
Country : US
Telephone Number : 916-737-5555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2021
Last Update Date : 03/19/2026

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Directions to “ KAITLYN ELIZABETH FAKOURI FNP-C” Practice Location

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