Provider Demographics
NPI:1538741426
Name:KIMATHI, BRENDA KANYUA (PMHNP-BC/ RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KANYUA
Last Name:KIMATHI
Suffix:
Gender:F
Credentials:PMHNP-BC/ RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N PROSPECTORS RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1258
Mailing Address - Country:US
Mailing Address - Phone:702-289-4157
Mailing Address - Fax:702-289-4795
Practice Address - Street 1:410 N PROSPECTORS RD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1258
Practice Address - Country:US
Practice Address - Phone:405-535-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036055363LP0808X
NV840834163W00000X, 363LP0808X
TX814690163W00000X
CA95418013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health