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NPI Code Detail

MEDICARE: PENINSULA COMMUNITY HEALTH SERVICES

MEDICARE: PENINSULA COMMUNITY HEALTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner
2207Q00000XFamily Medicine Physician
3207R00000XInternal Medicine Physician
4363A00000XPhysician Assistant
5363LP0808XPsychiatric/Mental Health Nurse Practitioner
6261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1538643853
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENINSULA COMMUNITY HEALTH SERVICES
Provider Business Mailing Address
First Line : PO BOX 960
Second Line :
City : BREMERTON
State : WA
Zip : 98337-0212
Country : US
Telephone Number : 360-377-3776
Fax Number :
Provider Business Practice Location Address
First Line : 627 W FRANKLIN ST
Second Line :
City : SHELTON
State : WA
Zip : 98584-3504
Country : US
Telephone Number : 360-377-3776
Fax Number :
Authorized Official
Title or Position : CEO
Name : JENNIFER KREIDLER-MOSS
Credential :
Telephone Number : 360-377-3776
Provider Enumeration Date : 09/21/2018
Last Update Date : 05/28/2026

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Directions to “PENINSULA COMMUNITY HEALTH SERVICES ” Practice Location

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