Provider Demographics
NPI:1477795805
Name:FOLSOM, FLENE A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:FLENE
Middle Name:A
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:FLENE
Other - Middle Name:A
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400 DATA DRIVE
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:530-273-4984
Mailing Address - Fax:530-273-7255
Practice Address - Street 1:4400 DUCKHORN DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834
Practice Address - Country:US
Practice Address - Phone:916-575-8000
Practice Address - Fax:916-575-8099
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19867OtherLICENSE
CAMB1835581OtherDEA