Provider Demographics
NPI:1598748345
Name:HERIDIA, CORIANDER KATHRYN (NP)
Entity Type:Individual
Prefix:MS
First Name:CORIANDER
Middle Name:KATHRYN
Last Name:HERIDIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CORIANDER
Other - Middle Name:K
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:417 104TH AVE E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6011
Mailing Address - Country:US
Mailing Address - Phone:253-324-5005
Mailing Address - Fax:
Practice Address - Street 1:12844 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3045
Practice Address - Country:US
Practice Address - Phone:253-324-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9208153363LF0000X
FLARNP9208153363LF0000X
WAARNP.AP.60265319-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001157200Medicaid
FLY00KXOtherBCBS
FLBO999XMedicare PIN