BONTU GUDETA KENTIBA ARNP
NPI 1902640105
Nurse Practitioner - Adult Health in Lacey, WA

Q: What is Bontu Kentiba's NPI number?

The NPI number for Bontu Kentiba is 1902640105. It was assigned to this individual provider in the NPPES registry on June 21, 2024.

Q: What is Bontu Kentiba's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Q: When was this NPI record last updated?

The NPPES record for Bontu Kentiba was last updated on October 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 21, 2024PECOS Enrolled

605 WOODLAND SQUARE LOOP SE, LACEY, WA 98503(360) 764-8000 Get Directions Write a Review

NPPES record last updated: October 19, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Bontu Gudeta Kentiba Arnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BONTU GUDETA KENTIBA ARNP (NPI 1902640105) is an individual adult health provider in Lacey, Washington, licensed in Washington (AP70057059) and active in the NPI registry since June 2024. The provider is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1902640105

Entity TypeIndividual

Primary Taxonomy363LA2200X

Provider Legal NameBONTU GUDETA KENTIBACredential: ARNP

Location Address605 WOODLAND SQUARE LOOP SELacey, WA 98503-1045

Mailing Address4410 Gallagher Way NwOlympia, WA 98502-9005

Phone(360) 764-8000

Sole ProprietorYes

Medical School CMSOtherGraduated 2025

Enumeration DateJune 21, 2024

Last NPPES UpdateOctober 19, 2025

NPPES CertifiedOctober 19, 2025

✔ NPI 1902640105 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2200X

License✔ Licensed in WA · AP70057059

605 WOODLAND SQUARE LOOP SE, Lacey, WA 98503

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Bontu Gudeta Kentiba Arnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1759865348

PECOS Enrollment IDI20260320003973

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98503 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.29 typical visit price

range $57.27 – $172.80

Typical copayment $22.07 (range $14.31 – $43.20)

Most-billed visit code 99203

Established Patient

$100.78 typical visit price

range $18.56 – $141.11

Typical copayment $25.19 (range $4.64 – $35.27)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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