Active NPI
Krystal Fosse, FNP-C
- Family Nurse Practitioner
- Clovis, CA
National Provider Identifier
1649510330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 22168
- Practice address
- 275 W Herndon Ave
Clovis, CA 93612-0204 - Phone
- (559) 324-6210
- NPI assigned
- Feb 18, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 22168 | CA | Primary |
Addresses
Primary practice location
275 W Herndon Ave
Clovis, CA 93612-0204
Mailing address
275 W Herndon Ave
Clovis, CA 93612-0204
Phone (559) 324-6210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22168 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418256000000",
"number": "1649510330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 W HERNDON AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936120204",
"telephone_number": "559-324-6210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 W HERNDON AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936120204",
"telephone_number": "559-324-6210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOSSE",
"first_name": "KRYSTAL",
"name_prefix": "Mrs.",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-18",
"last_updated": "2014-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "22168",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.