Provider Demographics
NPI:1831956739
Name:JAIME, KAELYNN DIANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:KAELYNN
Middle Name:DIANNE
Last Name:JAIME
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:KAELYNN
Other - Middle Name:DIANNE
Other - Last Name:GALEANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4234 HIDATSA ST
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-6874
Mailing Address - Country:US
Mailing Address - Phone:951-858-7484
Mailing Address - Fax:
Practice Address - Street 1:4234 HIDATSA ST
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-6874
Practice Address - Country:US
Practice Address - Phone:951-858-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily