Provider Demographics
NPI:1740829928
Name:GIBSON, KARLIE (RN)
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 23RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5728
Mailing Address - Country:US
Mailing Address - Phone:602-909-5313
Mailing Address - Fax:
Practice Address - Street 1:22232 17TH AVE SE STE 302
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7425
Practice Address - Country:US
Practice Address - Phone:425-487-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA60989257163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program