Vivian Kisanga, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61183787 Issued in WA

Practice address

18715 106TH Avenue CT E
Puyallup, WA 98374-8735

Phone

(206) 759-0207

NPI assigned

Nov 17, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, WA2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

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.

• Mindful Therapy Group PC

  dba Mindful Therapy Group

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Satish Narayan MD PA

  dba Psymed Solutions

  • Psychiatry Physician
  • Plano, TX
  • NPI 1659538775
  Medicare reassignment NPD
• Nisha Satish MD PA

  dba Primed Solutions

  • Family Medicine Physician
  • Greenville, TX
  • NPI 1902171226
  NPD (past)

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

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1821530155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18715 106TH AVENUE CT E STE 260",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983748735",
            "telephone_number": "817-657-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18715 106TH AVENUE CT E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983748735",
            "telephone_number": "206-759-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISANGA",
        "first_name": "VIVIAN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-17",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP132350",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61183787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanna L Kinzel
• Anne E. Kirk, MD
• David Daniel Kirk, DPT
• Kirks Pharmacy at Hartland, Inc. (Kirk's Pharmacy and Compounding)
• Kirks Pharmacy at Hartland, Inc. (Kirk's Pharmacy and Compounding)
• Alexandra Sonja Kissin, SLP
• Danae Elaine Kissner, PA
• Millenia Wu Kitikul, DMD
• Anthony J Klaassen, M.D.
• Christina Noel Klas, BS

• Psychiatric/Mental Health Nurse Practitioner in Puyallup, WA
• Providers in Puyallup, 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 Aug 25, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.