Provider Demographics
NPI:1790270296
Name:DYER, KENNETH BRITT (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BRITT
Last Name:DYER
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
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Mailing Address - Street 1:10333 19TH AVE, SE, S #109
Mailing Address - Street 2:S #109
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-742-4600
Mailing Address - Fax:425-225-6859
Practice Address - Street 1:10333 19TH AVE, SE
Practice Address - Street 2:STE #109
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-742-4600
Practice Address - Fax:425-225-6859
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARN60076562163W00000X
WAAP60863385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse