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General NPI Number Information
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NPI Number | 1699308239
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Entity Type | Individual
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Provider Name | JESSICA MYENDU KABALA
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 1100 9TH AVE
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City | SEATTLE
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State | WA
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Zip | 98101-2756
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Country | US
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Telephone | 206-223-2319
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Fax | 206-341-1405
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Provider Business Mailing Address
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Address Line | 1100 9TH AVE
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City | SEATTLE
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State | WA
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Zip | 98101-2756
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Country | US
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Telephone | 206-223-2319
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Fax | 206-341-1405
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 60696072
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61084558
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 31936
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License Number State | TN
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