Provider Demographics
NPI:1861366932
Name:BRACKEN, KELLY SUE (PMHNP)
Entity type:Individual
Prefix:
First Name:KELLY SUE
Middle Name:
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E EVERGREEN BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3264
Mailing Address - Country:US
Mailing Address - Phone:509-596-1138
Mailing Address - Fax:971-308-7811
Practice Address - Street 1:400 E EVERGREEN BLVD STE 217
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3264
Practice Address - Country:US
Practice Address - Phone:509-596-1138
Practice Address - Fax:971-308-7811
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP70050596363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health