Healthcare Provider Details

I. General information

NPI: 1902796816
Provider Name (Legal Business Name): GANIV KAUR KAHLON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 CLEVELAND AVE
MOUNT VERNON WA
98273-4215
US

IV. Provider business mailing address

1103 CLEVELAND AVE
MOUNT VERNON WA
98273-4215
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-6868
  • Fax:
Mailing address:
  • Phone: 360-336-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035690
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70078152
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: