Provider Demographics
NPI:1962510248
Name:CROSS, CARISSA C (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:C
Last Name:CROSS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:A
Other - Last Name:ANUAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1200 12TH AVE S
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:2601 SW KENYON ST
Practice Address - Street 2:NCH AT DENNY INTERNATIONAL MIDDLE SCHOOL
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126
Practice Address - Country:US
Practice Address - Phone:206-548-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60617269163W00000X
TX670495363L00000X
WAAP60647411363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ22857Medicare UPIN