Provider Demographics
NPI:1336368976
Name:KAY, JADE PACHECO (CFNP)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:PACHECO
Last Name:KAY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15462 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6141
Mailing Address - Country:US
Mailing Address - Phone:714-230-1779
Mailing Address - Fax:
Practice Address - Street 1:15462 VERMONT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6141
Practice Address - Country:US
Practice Address - Phone:714-230-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469068363LF0000X
CANP10918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP10918Medicare ID - Type Unspecified