Provider Demographics
NPI:1467045476
Name:KANANDA, KAREY (APRN)
Entity Type:Individual
Prefix:
First Name:KAREY
Middle Name:
Last Name:KANANDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21616 E WELLESLEY AVE, PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:OTIS ORCHARDS
Mailing Address - State:WA
Mailing Address - Zip Code:99027-2836
Mailing Address - Country:US
Mailing Address - Phone:208-261-2501
Mailing Address - Fax:877-935-2721
Practice Address - Street 1:23403 E MISSION AVE STE 220B
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5112
Practice Address - Country:US
Practice Address - Phone:208-261-2501
Practice Address - Fax:877-935-2721
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61149631363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health