Healthcare Provider Details

I. General information

NPI: 1265142236
Provider Name (Legal Business Name): ALEXINE KEJIKA NANSINLA PMHNP-BC, MS, BS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E LOGAN ST STE 201
CALDWELL ID
83605-4883
US

IV. Provider business mailing address

139 WAR ADMIRAL LN
NORTH LIBERTY IA
52317-2005
US

V. Phone/Fax

Practice location:
  • Phone: 208-454-1480
  • Fax: 208-268-8444
Mailing address:
  • Phone: 512-774-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7771142
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0100804-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: