Healthcare Provider Details

I. General information

NPI: 1548705320
Provider Name (Legal Business Name): NAOMI KIMANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN SUITE C 833
DALLAS TX
75230-2571
US

IV. Provider business mailing address

1711 MAIN ST
VANCOUVER WA
98660-2607
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-4591
  • Fax: 972-566-6679
Mailing address:
  • Phone: 360-200-4481
  • Fax: 360-799-4714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP132509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: