Active NPI
Busola R Jimoh, LPN
- Licensed Practical Nurse
- Everett, WA
National Provider Identifier
1396433389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 00048251
- Practice address
- 8831 Corbin Dr
Everett, WA 98204-7149 - Phone
- (425) 418-1732
- Fax
- (425) 582-8161
- NPI assigned
- Apr 27, 2023
- Last updated
- Apr 27, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 00048251 | WA | Primary |
Addresses
Primary practice location
8831 Corbin Dr
Everett, WA 98204-7149
Mailing address
15119 19TH PL W
Lynnwood, WA 98087-8764
Phone (425) 418-1732
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00048251 | WA | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KBDJ Inc | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682553600000",
"number": "1396433389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15119 19TH PL W",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980878764",
"telephone_number": "425-418-1732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8831 CORBIN DR",
"city": "EVERETT",
"state": "WA",
"postal_code": "982047149",
"telephone_number": "425-418-1732",
"fax_number": "425-582-8161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMOH",
"first_name": "BUSOLA",
"middle_name": "R",
"name_prefix": "Mrs.",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-27",
"last_updated": "2023-04-27",
"certification_date": "2023-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "WA",
"license": "00048251",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.