Provider Demographics
NPI:1639343007
Name:KAMALA, ELIETH KOKWESIGA
Entity Type:Individual
Prefix:
First Name:ELIETH
Middle Name:KOKWESIGA
Last Name:KAMALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIETH
Other - Middle Name:KOKWESIGA
Other - Last Name:KAMALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1902 SOLERA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-9135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:691 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3209
Practice Address - Country:US
Practice Address - Phone:614-574-1823
Practice Address - Fax:614-420-2229
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.126463164W00000X
OHAPRN.CNP.0034160363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse