Provider Demographics
NPI:1326417221
Name:MINOT, KACY (NNP-BC)
Entity Type:Individual
Prefix:
First Name:KACY
Middle Name:
Last Name:MINOT
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 4TH ST
Mailing Address - Street 2:1ST FLOOR ROOM C1940A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2351
Mailing Address - Country:US
Mailing Address - Phone:303-918-4827
Mailing Address - Fax:
Practice Address - Street 1:1975 4TH ST
Practice Address - Street 2:1ST FLOOR ROOM C1940A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2351
Practice Address - Country:US
Practice Address - Phone:303-918-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002902363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care