Provider Demographics
NPI:1376608307
Name:BASKIN-THOMPSON, MARY K (MSN, PMHNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:BASKIN-THOMPSON
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-304-4831
Mailing Address - Fax:
Practice Address - Street 1:1728 W MARINE VIEW DR STE 6
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2094
Practice Address - Country:US
Practice Address - Phone:425-339-5453
Practice Address - Fax:425-252-4441
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002103171100000X
WAAP61014304363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2147839Medicaid