Kairos Moment Healthcare and Behavioral Clinic - LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

KAIROS MOMENT HEALTHCARE AND BEHAVIORAL CLINIC - LLC

Practice address

9652 W Patrick LN
Peoria, AZ 85383-4319

Phone

(602) 410-0958

NPI assigned

Sep 26, 2023

Organization subpart

No

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

Authorized official

Name

Adesola Izasomeh, PMHNP - BCNPI 1720701261

Title

Nurse Practitioner

Phone

(602) 410-0958

Specialties & licenses 2

Addresses

Other names 1

• Kairos Moment Healthcare and Behavioral Clinic Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adesola Izasomeh, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1720701261
  NPD Authorized official
• Phillis Mutembete, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Tempe, AZ
  • NPI 1215230081
  NPD

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

{
    "created_epoch": "1695686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1457130676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9652 W PATRICK LN",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853834319",
            "telephone_number": "602-410-0958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9652 W PATRICK LN",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853834319",
            "telephone_number": "602-410-0958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAIROS MOMENT HEALTHCARE AND BEHAVIORAL CLINIC - LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-26",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "IZASOMEH",
        "authorized_official_first_name": "ADESOLA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "602-410-0958",
        "authorized_official_credential": "PMHNP - BC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kairos Moment Healthcare and Behavioral Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kairos Moment Healthcare and Behavioral Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jupiter Medical Services LLC
• Michelle Elizabeth Juslin
• Sylvia Ann Justiss, PTA
• Darian Kaar, DDS, MSD
• Meghann Marie Kahabka
• Bhumit Kalavadiya, PHARMD
• Martin Kallookaran
• Tara Kalton, PHARMD
• Medina Makena Kamau, PMHNP
• Sylvia Kamel, DDS

• Mental Health Clinic/Center (Including Community Mental Health Center) in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.