Healthcare Provider Details

I. General information

NPI: 1154267243
Provider Name (Legal Business Name): DESIREE NIKITA KEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S MAGNOLIA AVE APT 250
ANAHEIM CA
92804-2159
US

IV. Provider business mailing address

150 S MAGNOLIA AVE APT 250
ANAHEIM CA
92804-2159
US

V. Phone/Fax

Practice location:
  • Phone: 661-271-0986
  • Fax:
Mailing address:
  • Phone: 661-271-0986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95317273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: