Provider Demographics
NPI:1508581471
Name:KANGARA, JOHN KIMEMIA (LPN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KIMEMIA
Last Name:KANGARA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9826 WASHINGTON BLVD SW
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1262
Mailing Address - Country:US
Mailing Address - Phone:913-749-6586
Mailing Address - Fax:
Practice Address - Street 1:9826 WASHINGTON BLVD SW
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498-1262
Practice Address - Country:US
Practice Address - Phone:913-749-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61094903164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse