Provider Demographics
NPI:1265975148
Name:KLITH, DAISY (NP)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:KLITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:530-333-2548
Mailing Address - Fax:
Practice Address - Street 1:6065 HIGHWAY 193
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:CA
Practice Address - Zip Code:95634
Practice Address - Country:US
Practice Address - Phone:530-333-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005493207QA0401X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005493OtherCA BRN