Healthcare Provider Details

I. General information

NPI: 1871959312
Provider Name (Legal Business Name): TISAYA KARNNET PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-2309
  • Fax:
Mailing address:
  • Phone: 626-397-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95032869
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number779204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: