Provider Demographics
NPI:1003952870
Name:CHILDRESS, KRISTEN M (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 POINT FOSDICK DR NW
Mailing Address - Street 2:PMB 27
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1711
Mailing Address - Country:US
Mailing Address - Phone:360-710-3319
Mailing Address - Fax:360-876-0878
Practice Address - Street 1:2431 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-1302
Practice Address - Country:US
Practice Address - Phone:360-710-3319
Practice Address - Fax:360-876-0878
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00138087363LA2200X
WAAP30006700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0225388OtherSTATE L & I
WA0258710OtherSTATE L & I
WA0258710OtherSTATE L & I
WA0225388OtherSTATE L & I
WAQ64800Medicare UPIN
WAG8888060Medicare PIN