Provider Demographics
NPI:1568965598
Name:SOUZA, KD GRACE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KD
Middle Name:GRACE
Last Name:SOUZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KD
Other - Middle Name:GRACE
Other - Last Name:PFAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:93 WOOD DUCK DR
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9057
Mailing Address - Country:US
Mailing Address - Phone:559-786-9403
Mailing Address - Fax:
Practice Address - Street 1:5361 E KINGS CANYON RD STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4908
Practice Address - Country:US
Practice Address - Phone:559-251-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95006951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily