Provider Demographics
NPI:1235424375
Name:MYERS, KRISTEN R (PSYD, DRPH)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:R
Last Name:MYERS
Suffix:
Gender:F
Credentials:PSYD, DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 176TH AVE E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-9417
Mailing Address - Country:US
Mailing Address - Phone:909-567-9637
Mailing Address - Fax:253-862-9951
Practice Address - Street 1:310 N MERIDIAN
Practice Address - Street 2:STE 205
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8644
Practice Address - Country:US
Practice Address - Phone:909-567-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60200339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical