Provider Demographics
NPI:1467544221
Name:GALITSIS, KRISTA GAINES (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:GAINES
Last Name:GALITSIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTA
Other - Middle Name:LEE
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 E. KINKAID STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:96274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:326 S. STILLAGUAMISH AVE.
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-435-2144
Practice Address - Fax:360-435-9601
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400673208000000X
WAMD60197795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137XTMedicaid
137XTOtherBCBS
NC2043939Medicare PIN
NCF59642Medicare UPIN