Provider Demographics
NPI:1376282178
Name:SORENSON, KELLEIGH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLEIGH
Middle Name:
Last Name:SORENSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 BUENA VISTA DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-8581
Mailing Address - Country:US
Mailing Address - Phone:805-395-3277
Mailing Address - Fax:805-591-4107
Practice Address - Street 1:2727 BUENA VISTA DR STE 201
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-8581
Practice Address - Country:US
Practice Address - Phone:805-395-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA659914163W00000X
CA95021825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse