Provider Demographics
NPI:1396141743
Name:FJELD, KERRI (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:FJELD
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 GRAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1000
Mailing Address - Country:US
Mailing Address - Phone:510-428-4900
Mailing Address - Fax:510-428-4904
Practice Address - Street 1:1345 GRAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1000
Practice Address - Country:US
Practice Address - Phone:510-428-4900
Practice Address - Fax:510-428-4904
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily