Provider Demographics
NPI:1568823748
Name:KLOCKE, HEATHER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:KLOCKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:ULRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19304 24TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6900
Mailing Address - Country:US
Mailing Address - Phone:206-331-3810
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60635388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily