Provider Demographics
NPI:1134873656
Name:NEFZGER, KYLE DANIEL (FNP-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DANIEL
Last Name:NEFZGER
Suffix:
Gender:M
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 1:3860 EL DORADO HILLS BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4563
Mailing Address - Country:US
Mailing Address - Phone:916-941-9222
Mailing Address - Fax:
Practice Address - Street 1:3860 EL DORADO HILLS BLVD STE 601
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4563
Practice Address - Country:US
Practice Address - Phone:916-941-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily