Provider Demographics
NPI:1851858641
Name:KEYA, DOMINIC KENYANYA (NP)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:KENYANYA
Last Name:KEYA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 185TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9051
Mailing Address - Country:US
Mailing Address - Phone:253-325-1121
Mailing Address - Fax:425-536-8707
Practice Address - Street 1:510 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-5698
Practice Address - Country:US
Practice Address - Phone:253-325-1121
Practice Address - Fax:425-536-4707
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60797352163W00000X
WAAP61451476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse