Healthcare Provider Details

I. General information

NPI: 1184128472
Provider Name (Legal Business Name): ESTHER KIMANI NYONI REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date: 11/15/2023
Reactivation Date: 06/25/2025

III. Provider practice location address

5044 CAMPGROUND RD
EDEN MD
21822-2127
US

IV. Provider business mailing address

5044 CAMPGROUND RD
EDEN MD
21822-2127
US

V. Phone/Fax

Practice location:
  • Phone: 918-408-6772
  • Fax:
Mailing address:
  • Phone: 918-408-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR210878
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024194132
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: