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General NPI Number Information
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NPI Number | 1407379134
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Entity Type | Individual
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Provider Name | NAOMI JEPKORIR MUTAI
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Gender | Female
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 07/25/2017
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Provider Practice Location Address
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Address Line | 14121 PARKE LONG CT STE 201
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City | CHANTILLY
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State | VA
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Zip | 20151-1647
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Country | US
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Telephone | 855-247-1940
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Fax | 844-379-5385
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Provider Business Mailing Address
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Address Line | 1502 W MULBERRY ST
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City | OLATHE
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State | KS
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Zip | 66061-2571
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Country | US
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Telephone | 913-549-3232
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Fax | 913-732-2381
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53-77544-102
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License Number State | KS
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