Provider Demographics
NPI:1700901543
Name:KUNKLE, ROBERT L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:KUNKLE
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 PLUMAS STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-821-5865
Mailing Address - Fax:530-673-4388
Practice Address - Street 1:1215 PLUMAS STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-821-5865
Practice Address - Fax:530-673-4388
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA23038111N00000X
CA95013803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor