MEDICARE: KELVIN K KIBATHI

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	LP61330844	WA

General Provider Information

NPI Number	:	1871446336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELVIN K KIBATHI

Provider Business Mailing Address
First Line	:	3005 S 47TH ST APT 48
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-6561
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 S 47TH ST APT 48
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-6561
Country	:	US
Telephone Number	:	253-888-9417
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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