Healthcare Provider Details

I. General information

NPI: 1780121582
Provider Name (Legal Business Name): JOTHAM KAHORO GIKUHI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 SONOMA AVE
SANTA ROSA CA
95404-4818
US

IV. Provider business mailing address

PO BOX 14761
SANTA ROSA CA
95402-6761
US

V. Phone/Fax

Practice location:
  • Phone: 707-583-8700
  • Fax: 707-303-4066
Mailing address:
  • Phone: 707-623-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number86958
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95006950
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number740595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: