Healthcare Provider Details

I. General information

NPI: 1225847940
Provider Name (Legal Business Name): PATRICK KIMANI WAIRIRI RN, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9259 CRYSTAL FALLS WAY
ELK GROVE CA
95624-4054
US

IV. Provider business mailing address

9259 CRYSTAL FALLS WAY
ELK GROVE CA
95624-4054
US

V. Phone/Fax

Practice location:
  • Phone: 972-955-7335
  • Fax:
Mailing address:
  • Phone: 972-955-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95038291
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95427726
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: