Provider Demographics
NPI:1558763516
Name:PARK, KRISTIN A (DNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:PARK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10863 SE 218TH PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1373
Mailing Address - Country:US
Mailing Address - Phone:253-307-9681
Mailing Address - Fax:
Practice Address - Street 1:17700 SE 272ND ST # 400
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4951
Practice Address - Country:US
Practice Address - Phone:253-372-6512
Practice Address - Fax:253-372-6527
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV814227363LF0000X
WAAP60491879363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily