Provider Demographics
NPI:1073890737
Name:MOUA, KAY L (ARNP)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:L
Last Name:MOUA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16404 SMOKEY POINT BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8417
Mailing Address - Country:US
Mailing Address - Phone:425-318-7144
Mailing Address - Fax:425-748-7378
Practice Address - Street 1:16404 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:425-318-7144
Practice Address - Fax:425-748-7378
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60236013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2125115Medicaid
WAAP60236013OtherLICENSE
WA2015343Medicaid