Provider Demographics
NPI:1649835471
Name:GAINES-GLYNN, STARR S (NP-C)
Entity type:Individual
Prefix:
First Name:STARR
Middle Name:S
Last Name:GAINES-GLYNN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6638 W RIALTO AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93723-9463
Mailing Address - Country:US
Mailing Address - Phone:559-270-1898
Mailing Address - Fax:
Practice Address - Street 1:5464 N PALM AVE STE A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1946
Practice Address - Country:US
Practice Address - Phone:559-432-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
CA950004595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No374J00000XNursing Service Related ProvidersDoula