Healthcare Provider Details

I. General information

NPI: 1922833128
Provider Name (Legal Business Name): CAROLINE CARLYN NJOKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 E HARRY CT
WICHITA KS
67207-2901
US

IV. Provider business mailing address

5508 DODGE CT
WICHITA KS
67217-6400
US

V. Phone/Fax

Practice location:
  • Phone: 316-796-3710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number83386
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: