Provider Demographics
NPI:1598639957
Name:KHISA, LYNDA I
Entity type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:I
Last Name:KHISA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 300TH ST NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-5841
Mailing Address - Country:US
Mailing Address - Phone:360-209-8430
Mailing Address - Fax:360-474-4024
Practice Address - Street 1:7700 300TH ST NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-5841
Practice Address - Country:US
Practice Address - Phone:360-209-8430
Practice Address - Fax:360-474-4024
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN6149353163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health