Provider Demographics
NPI:1336786920
Name:KOKINAKOS, ANGELA PHOENIX (ARNP)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:PHOENIX
Last Name:KOKINAKOS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 13TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1689
Mailing Address - Country:US
Mailing Address - Phone:425-261-2000
Mailing Address - Fax:
Practice Address - Street 1:5007 CLAREMONT WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-3321
Practice Address - Country:US
Practice Address - Phone:425-609-5005
Practice Address - Fax:425-609-5506
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61320024363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health