Kimberly Gonzalez, NP-C
Individual provider Active NPI Primary Care Nurse Practitioner · Shafter, CA
NPI 1902364151 · NPPES record last updated Mar 6, 2019
Key facts
- NPI
- 1902364151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 95011159 (CA)
- Practice address
- 565 Kern St
Shafter, CA 93263-2133 - Phone
- (661) 459-1000
- NPI assigned
- Mar 6, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190329000507 | CA | Practitioner - Nurse Practitioner | 2567702525 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95011159 | CA | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vanguard Medical Corporation | Current | Accepting new patients | |
| Vanguard Medical Corporation | Current |
Accepting new patients | |
| Vanguard Medical Corporation | Current |
Accepting new patients |
Locations
565 Kern St
Shafter, CA 93263
Phone (661) 746-4937
845 7th St
Wasco, CA 93280
Phone (661) 459-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 95011159 | CA | Yes |
Addresses
Primary practice location
565 Kern St
Shafter, CA 93263-2133
Mailing address
565 Kern St
Shafter, CA 93263-2133
Phone (661) 459-1000
Other practice location 1
845 7th St
Wasco, CA 93280-1919
Phone (661) 459-1000
Other providers in Shafter, CA
- Rubie Galoyo
- Alicia E Garcia
- Desiree Garza
- Glinn and Giordano Physical Therapy Inc.
- Bernadette Lynne Advincula Gonzalez
- Good Samaritan Hospital Ca LTD PTP
- Grow Public Schools
- Sophia Medina Guerra
- Harmonia Birth Doula LLC
- Angela D Hernandez
All providers in Shafter, CA · Primary Care Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.