Healthcare Provider Details

I. General information

NPI: 1467544221
Provider Name (Legal Business Name): KRISTA GAINES GALITSIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA LEE GAINES MD

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S. STILLAGUAMISH AVE.
ARLINGTON WA
98223
US

IV. Provider business mailing address

1400 E. KINKAID STREET
MOUNT VERNON WA
96274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-435-2144
  • Fax: 360-435-9601
Mailing address:
  • Phone: 360-428-2500
  • Fax: 360-428-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200400673
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60197795
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: