Healthcare Provider Details

I. General information

NPI: 1922635887
Provider Name (Legal Business Name): CASCADE NURSE PRACTITIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S 19TH ST
TACOMA WA
98405-2962
US

IV. Provider business mailing address

5409 100TH ST SW UNIT 39800
LAKEWOOD WA
98496-0970
US

V. Phone/Fax

Practice location:
  • Phone: 253-433-0910
  • Fax: 253-242-1958
Mailing address:
  • Phone: 253-433-0910
  • Fax: 253-242-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LOCKY KAMAU
Title or Position: OWNER OF ENTITY
Credential:
Phone: 253-433-0910