=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962224964
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL MATHENGE PMHNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2024
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1402 LAKE TAPPS PKWY SE STE F104
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98092-8157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-683-7483
-----------------------------------------------------
Fax | 253-237-9329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21915 26TH ST E
-----------------------------------------------------
City | LAKE TAPPS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98391-5642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-228-1481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP61621274
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------