Healthcare Provider Details

I. General information

NPI: 1457837486
Provider Name (Legal Business Name): NISSA LOVING KISLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BINKLEY ST STE 101
SOLDOTNA AK
99669-7500
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100 ATTN CREDENTIALING
RENTON WA
98057
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4111
  • Fax: 844-912-3953
Mailing address:
  • Phone: 425-690-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN60937074
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60937076
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: