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General NPI Number Information
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NPI Number | 1851858641
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Entity Type | Individual
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Provider Name | DOMINIC KENYANYA KEYA NP
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Gender | Male
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 510 E MAIN
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City | PUYALLUP
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State | WA
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Zip | 98372-5698
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Country | US
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Telephone | 253-325-1121
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Fax | 800-807-9176
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Provider Business Mailing Address
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Address Line | 7613 185TH STREET CT E
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City | PUYALLUP
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State | WA
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Zip | 98375-9051
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Country | US
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Telephone | 253-325-1121
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Fax | 800-807-9176
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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 | AP61451476
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN60797352
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License Number State | WA
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