Healthcare Provider Details

I. General information

NPI: 1962224964
Provider Name (Legal Business Name): PAUL MATHENGE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 LAKE TAPPS PKWY SE STE F104
AUBURN WA
98092-8157
US

IV. Provider business mailing address

21915 26TH ST E
LAKE TAPPS WA
98391-5642
US

V. Phone/Fax

Practice location:
  • Phone: 253-683-7483
  • Fax: 253-237-9329
Mailing address:
  • Phone: 253-228-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61621274
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: