Provider Demographics
NPI:1043929581
Name:KIMANI, JACQUELINE WARUI (PMHNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:WARUI
Last Name:KIMANI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38036 39TH AVE S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-8784
Mailing Address - Country:US
Mailing Address - Phone:253-266-8212
Mailing Address - Fax:
Practice Address - Street 1:38036 39TH AVE S # NA
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-8784
Practice Address - Country:US
Practice Address - Phone:253-266-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60349857163W00000X
WAAP61510073363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse