Healthcare Provider Details

I. General information

NPI: 1609635804
Provider Name (Legal Business Name): YOHANES MEZENGHIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW HOLDEN ST
SEATTLE WA
98126-3505
US

IV. Provider business mailing address

325 W GOWE ST
KENT WA
98032-5892
US

V. Phone/Fax

Practice location:
  • Phone: 203-933-7199
  • Fax:
Mailing address:
  • Phone: 253-833-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP.70098386-NP
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60960125
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: