Individual provider Active NPI

Katrina Anne Engstrom, FNP-C

  • Family Nurse Practitioner
  • Fairfield, CA
National Provider Identifier
1679248199
Registry record updated Jun 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95017413 Issued in CA
Practice address
1325 Travis Blvd Ste C
Fairfield, CA 94533-4611
Phone
(707) 429-8855
NPI assigned
Aug 16, 2021
Last updated
Jun 1, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95017413 CA Primary

Addresses

Primary practice location

1325 Travis Blvd Ste C
Fairfield, CA 94533-4611

Mailing address

1325 Travis Blvd Ste C
Fairfield, CA 94533-4611
Phone (925) 887-5398

Other identifiers 1

IdentifierTypeStateIssuer
95017413OtherCASTATE OF CALIFORNIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230824004395 CA Order and Referring Only - Nurse Practitioner 7012370935

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95030000CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Planned Parenthood Shasta Diablo Inc Past Accepting new patients
Pain and Rehabilitative Consultants Medical Group PastSince Aug 28, 2021 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780272000000",
    "number": "1679248199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 TRAVIS BLVD STE C",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945334611",
            "telephone_number": "925-887-5398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 TRAVIS BLVD STE C",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945334611",
            "telephone_number": "707-429-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGSTROM",
        "first_name": "KATRINA",
        "middle_name": "ANNE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-16",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95017413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF CALIFORNIA",
            "identifier": "95017413",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CA

Sources for this page

Verify at the official NPI Registry.