Knickerbocker, Kelly Marie
Knickerbocker, Kelly Marie is an sole proprietor health care provider with primary practice located at 23007 Lakeview Dr Unit A203 , Mountlake Terrace WA 98043-2378. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Knickerbocker, Kelly Marie can be contacted via phone (425) 954-3330.Contact Information
Primary practice address
23007 Lakeview Dr Unit A203
Mountlake Terrace WA 98043-2378
Phone: (425) 954-3330
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | AP 60448879 | Washington |
Profile Details
| NPI number | 1427304138 |
|---|---|
| LBN Legal business name | Knickerbocker, Kelly Marie |
| Credentials | MSN RN PMHNP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 31st, 2012 |
| Last updated | Dec 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427304138 | NPPES |
| Other | 1710599158 | ORGANIZATIONAL NPI 2 |
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