Provider Demographics
NPI:1417524190
Name:KIEST, KARALYN (FNP)
Entity Type:Individual
Prefix:
First Name:KARALYN
Middle Name:
Last Name:KIEST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KARALYN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-773-2882
Mailing Address - Fax:760-773-2680
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-773-2882
Practice Address - Fax:760-773-2680
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily