Nicolette Bautista, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

28563 Issued in CA

Practice address

110 Blue Ravine Rd Ste 104
Folsom, CA 95630-4712

Phone

(916) 505-4419

Fax

(916) 805-5145

NPI assigned

Jan 26, 2010

Last updated

Feb 4, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Westcoast Trauma and Testing Specialists, Inc.

  dba Kap Wellness

  • Clinical Psychologist
  • Folsom, CA
  • NPI 1063278943
  NPD Authorized official

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

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1932430212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BLUE RAVINE RD STE 104",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956304712",
            "telephone_number": "916-505-4419",
            "fax_number": "916-805-5145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BLUE RAVINE RD STE 104",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956304712",
            "telephone_number": "916-505-4419",
            "fax_number": "916-805-5145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "NICOLETTE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-26",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "28563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1063278943",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL GOVERNMENT",
            "identifier": "834276744",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Namuun Bat, ND
• Tessa Marie Batchelor, LCSW
• Vera Batchu, MD
• Baum Anesthesia Consultants a Professional Nursing Anesthesia Co (Baum Anesthesia Consultants)
• Andy Baum, CRNA
• Bay Area Foot Care, Inc (Bay Area Foot Care)
• Bay Area Foot Care, Inc
• Bay Area Foot Care, Inc (Bay Area Foot Care)
• Kathleen Ann Beavers, MSW
• Katie Becker

• Clinical Psychologist in Folsom, CA
• Providers in Folsom, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.