Provider Demographics
NPI:1255067856
Name:GATES, KIERSTYN (FNP-C)
Entity type:Individual
Prefix:
First Name:KIERSTYN
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KIERSTYN
Other - Middle Name:
Other - Last Name:POLTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 W JANSS RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 W JANSS RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1847
Practice Address - Country:US
Practice Address - Phone:805-497-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95020755363LF0000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily