Provider Demographics
NPI:1346041118
Name:FAUTNER, KIANDRA LENAE
Entity type:Individual
Prefix:
First Name:KIANDRA
Middle Name:LENAE
Last Name:FAUTNER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S RICHMOND RD APT A
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-4465
Mailing Address - Country:US
Mailing Address - Phone:760-382-0622
Mailing Address - Fax:
Practice Address - Street 1:405 S RICHMOND RD APT A
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-4465
Practice Address - Country:US
Practice Address - Phone:760-382-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle