KELLY MARIE KNICKERBOCKER MSN RN PMHNP NPI 1427304138

NPI Information

NPI: 1427304138
Provider Name: KELLY MARIE KNICKERBOCKER, MSN RN PMHNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

Address:
23007 LAKEVIEW DR UNIT A203
MOUNTLAKE TERRACE, WA
ZIP 98043
Phone: (425) 954-3330
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Kelly Marie Knickerbocker, MSN RN PMHNP is a psychiatric/mental health nurse practitioner in Mountlake Terrace, WA. Kelly Marie Knickerbocker, MSN RN PMHNP NPI is 1427304138. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

23007 LAKEVIEW DR UNIT A203
MOUNTLAKE TERRACE, WA
ZIP 98043-378
Phone: (425) 954-3330

The enumeration date for this NPI number is 7/31/2012 and was last updated on 12/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	AP 60448879	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1710599158	OTHER		ORGANIZATIONAL NPI 2

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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