Provider Demographics
NPI:1194518548
Name:COULTER, KIRSTIN (BSN, RN, PHN)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:COULTER
Suffix:
Gender:F
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-5512
Mailing Address - Country:US
Mailing Address - Phone:661-837-6000
Mailing Address - Fax:
Practice Address - Street 1:1624 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-5512
Practice Address - Country:US
Practice Address - Phone:661-837-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA753329163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty