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Individual

KARI LYNN PROVOST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
12595 HESPERIA RD STE 101, VICTORVILLE, CA 92395
(760) 881-3377
(760) 881-3379
Mailing address
12595 HESPERIA RD STE 101, VICTORVILLE, CA 92395-5882
(760) 881-3377
(760) 881-3379

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA22507
CA

Other

Enumeration date
09/04/2012
Last updated
07/30/2018
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