Provider Demographics
NPI:1477239911
Name:MITCHELL, KRISTY MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:MITCHELL
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 1:195 NE GILMAN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2940
Mailing Address - Country:US
Mailing Address - Phone:425-295-7697
Mailing Address - Fax:
Practice Address - Street 1:195 NE GILMAN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2940
Practice Address - Country:US
Practice Address - Phone:425-295-7697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60474662163W00000X
WAAP61579530363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse