Jean Clement Nikubwayo, ARNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61576057 Issued in WA

Practice address

3510 Steelhammer Dr
Centralia, WA 98531-1532

Phone

(360) 623-8020

Fax

(360) 623-1072

NPI assigned

Sep 16, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cascade Community Healthcare

  • Family Medicine Physician
  • Centralia, WA
  • NPI 1568152486
  NPD
• Cascade Community Healthcare

  dba Cascade Mental Health Care

  • Community/Behavioral Health Agency
  • Centralia, WA
  • NPI 1619068624
  NPD
• Cascade Evaluation and Treatment Center

  • Mental Illness Community Based Residential Treatment Facility
  • Centralia, WA
  • NPI 1760979298
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1093542946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2428 W REYNOLDS AVE",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985314554",
            "telephone_number": "360-330-9044",
            "fax_number": "360-736-0689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 STEELHAMMER DR",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985311532",
            "telephone_number": "360-623-8020",
            "fax_number": "360-623-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKUBWAYO",
        "first_name": "JEAN",
        "middle_name": "CLEMENT",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61576057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dylan Joseph Newberry
• Gideon Newkirk
• Kathy Ka Pik NG, PHARMD
• Lynda Nguyen, RD
• Margaret Lily Nice, MD
• Mark Nishiyama, MD
• Peter Nganga Njeri, RN
• Johnson Njoroge, CNA
• Matthew Noble, COTA
• Patty Kathleen Noble, LPN

• Psychiatric/Mental Health Nurse Practitioner in Centralia, WA
• Providers in Centralia, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.