Healthcare Provider Details

I. General information

NPI: 1790635944
Provider Name (Legal Business Name): RANDALL JAY ENSMINGER PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 E TRENT AVE
SPOKANE WA
99212-1315
US

IV. Provider business mailing address

4305 E TRENT AVE
SPOKANE WA
99212-1315
US

V. Phone/Fax

Practice location:
  • Phone: 509-495-1207
  • Fax:
Mailing address:
  • Phone: 509-495-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN6085914
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: