Provider Demographics
NPI:1649800426
Name:BARRANTES, KERBIE SALVADOR A (ARNP)
Entity type:Individual
Prefix:
First Name:KERBIE SALVADOR
Middle Name:A
Last Name:BARRANTES
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 WALTHEW DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-4156
Mailing Address - Country:US
Mailing Address - Phone:646-671-9790
Mailing Address - Fax:
Practice Address - Street 1:11318 BRIDGEPORT WAY SW
Practice Address - Street 2:STE A
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3054
Practice Address - Country:US
Practice Address - Phone:253-533-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61026274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily