MEDICARE: ANNE ELIZABETH KOOMEN ARNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60298613	WA
2	163W00000X	Registered Nurse	778674	CA

General Provider Information

NPI Number	:	1629351317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE ELIZABETH KOOMEN ARNP

Provider Business Mailing Address
First Line	:	PO BOX 1093
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-1093
Country	:	US
Telephone Number	:	415-847-4643
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 TAYLOR ST STE 35B
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-5758
Country	:	US
Telephone Number	:	206-279-4547
Fax Number	:	206-397-0891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	06/05/2026

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