Provider Demographics
NPI:1235696287
Name:KALLEMEYN, RACHEL JANETTE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:JANETTE
Last Name:KALLEMEYN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:JANETTE
Other - Last Name:HUDLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 N SEE VEE LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8130
Mailing Address - Country:US
Mailing Address - Phone:760-873-8464
Mailing Address - Fax:760-873-3935
Practice Address - Street 1:199 TWIN LAKES ROAD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CA
Practice Address - Zip Code:93517
Practice Address - Country:US
Practice Address - Phone:530-495-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP11576FMedicaid