Provider Demographics
NPI:1184409716
Name:GAUTAM, GAYATRI (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:GAYATRI
Middle Name:
Last Name:GAUTAM
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 1:3414 BRIDGET AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-5460
Mailing Address - Country:US
Mailing Address - Phone:661-565-4134
Mailing Address - Fax:
Practice Address - Street 1:212 COFFEE RD STE 203
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1274
Practice Address - Country:US
Practice Address - Phone:661-885-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily