Provider Demographics
NPI:1235696568
Name:PREMIER DIABETES CARE, PLLC
Entity Type:Organization
Organization Name:PREMIER DIABETES CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOUA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-344-0929
Mailing Address - Street 1:16404 SMOKEY POINT BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1235696568OtherNPI
WA2125115Medicaid
WAG8995537OtherMEDICARE