Provider Demographics
NPI:1720541683
Name:HARKNESS, KELLIE ANNE (MSN, APRN)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANNE
Last Name:HARKNESS
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 BLACK HILLS LN SW STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8142
Mailing Address - Country:US
Mailing Address - Phone:360-995-4219
Mailing Address - Fax:360-562-0635
Practice Address - Street 1:412 BLACK HILLS LN SW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8142
Practice Address - Country:US
Practice Address - Phone:360-995-4219
Practice Address - Fax:360-562-0635
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS115697163W00000X
WAN361025137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse