Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | RN00138087 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP30006700 | WA |
NPI | 1003952870 |
---|---|
Provider Name | Kristen M Childress |
First Address | Gig Harbor, WA 98335-1711 |
Second Address | Port Orchard, WA 98366-1302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 10/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0225388 | STATE L & I (01) | WA |
0258710 | STATE L & I (01) | WA |
Q64800 | (02) | WA |