Healthcare Provider Details

I. General information

NPI: 1639343007
Provider Name (Legal Business Name): ELIETH KOKWESIGA KAMALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIETH KOKWESIGA KAMALA

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-3209
US

IV. Provider business mailing address

1902 SOLERA DR
COLUMBUS OH
43229-9135
US

V. Phone/Fax

Practice location:
  • Phone: 614-574-1823
  • Fax: 614-420-2229
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0034160
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.126463
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: