MEDICARE: JOHN KIMEMIA KANGARA LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LP61094903	WA

General Provider Information

NPI Number	:	1508581471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KIMEMIA KANGARA LPN

Provider Business Mailing Address
First Line	:	9826 WASHINGTON BLVD SW
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98498-1262
Country	:	US
Telephone Number	:	913-749-6586
Fax Number	:

Provider Business Practice Location Address
First Line	:	9826 WASHINGTON BLVD SW
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98498-1262
Country	:	US
Telephone Number	:	913-749-6586
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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