Kenneth Nembu, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

240670 Issued in AZ

Practice address

13060 S Sunland Gin Rd
Arizona City, AZ 85123-8448

Phone

(520) 387-5651

NPI assigned

Apr 24, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ, WA, OR3 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 3

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.nembu.p1@direct.cbridges.nextgenshare.com

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.

• Mind 247 Practice LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Phoenix, AZ
  • NPI 1902472467
  Medicare reassignment NPD
• Legacy Emanuel Hospital & Health Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1831112358
  Medicare reassignment NPD
• Lgbtq Telepsychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Sheridan, WY
  • NPI 1336722859

  OR

  Medicare reassignment NPD
• Connectionsaz, LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1083840953
  Medicare reassignment
• Mind 247 Practice LLC

  • Psychiatry Physician
  • Mesa, AZ
  • NPI 1659089951
  NPD
• Mind 247 Practice LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mesa, AZ
  • NPI 1750058244
  NPD
• Legacy Emanuel Hospital & Health Center

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1417977976
  NPD
• Legacy Emanuel Hospital & Health Center

  • Clinic/Center
  • Portland, OR
  • NPI 1700809027
  NPD
• Connectionswa, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kirkland, WA
  • NPI 1558042234
  NPD (past)

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

{
    "created_epoch": "1587686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761609600000",
    "number": "1841810371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N MALACATE ST",
            "city": "AJO",
            "state": "AZ",
            "postal_code": "853212254",
            "telephone_number": "520-387-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13060 S SUNLAND GIN RD",
            "city": "ARIZONA CITY",
            "state": "AZ",
            "postal_code": "851238448",
            "telephone_number": "520-387-5651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "410 N Malacate St",
            "address_purpose": "LOCATION",
            "city": "Ajo",
            "state": "AZ",
            "postal_code": "853212254",
            "country_code": "US",
            "telephone_number": "520-387-5651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1225 NE 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322003",
            "country_code": "US",
            "telephone_number": "503-944-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEMBU",
        "first_name": "KENNETH",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-24",
        "last_updated": "2025-10-28",
        "certification_date": "2025-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10034566",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "240670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "240670",
            "identifier": "240670",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "AJO",
            "affiliation": "N",
            "address_1": "410 N Malacate St",
            "city": "Ajo",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "853212254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Petra Rosa Mojica
• Sue A Moler, PSYD
• Gilbert Joseph Montano, FNP-BC
• Cecilia Araceli Munoz, NP
• Brenda Lee Neeley, LMSW, LISAC
• Steven Ong
• Annabel Owusu
• Park Place Outreach & Counseling Centers, Inc.
• Park Place Outreach and Counseling Centers Inc
• Park Place Outreach and Counseling Centers Inc

• Psychiatric/Mental Health Nurse Practitioner in Arizona City, AZ
• Providers in Arizona City, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2025; 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.