Provider Demographics
NPI:1881055283
Name:O'HARA, KYLE DAILEY
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DAILEY
Last Name:O'HARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 JEFFERSON ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2444
Mailing Address - Country:US
Mailing Address - Phone:707-321-3071
Mailing Address - Fax:
Practice Address - Street 1:1333 JEFFERSON ST
Practice Address - Street 2:SUITE F
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2444
Practice Address - Country:US
Practice Address - Phone:707-321-3071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440537163W00000X
CA95018670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse