Provider Demographics
NPI:1023552726
Name:HARMS, KYLIE (FNP)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:HARMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:RUZICKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 BECK AVE
Mailing Address - Street 2:MS 9100
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6804
Mailing Address - Country:US
Mailing Address - Phone:707-784-8193
Mailing Address - Fax:
Practice Address - Street 1:275 BECK AVE
Practice Address - Street 2:MS 9100
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6804
Practice Address - Country:US
Practice Address - Phone:707-784-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005692363LF0000X
NY348539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily