Provider Demographics
NPI:1215334172
Name:KAMAU, MEDINA MAKENA (PMHNP)
Entity type:Individual
Prefix:MS
First Name:MEDINA
Middle Name:MAKENA
Last Name:KAMAU
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 N CENTRAL AVE STE 1050
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1217
Mailing Address - Country:US
Mailing Address - Phone:602-266-8402
Mailing Address - Fax:602-264-0887
Practice Address - Street 1:9051 W KELTON LN STE 13
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3533
Practice Address - Country:US
Practice Address - Phone:623-815-5700
Practice Address - Fax:623-815-5759
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7446363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ977306Medicaid
AZZ176165Medicare PIN