Healthcare Provider Details

I. General information

NPI: 1235612433
Provider Name (Legal Business Name): KRISTIN MARIE GEDDES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 WINTERGREEN LN NE
BAINBRIDGE ISLAND WA
98110-5147
US

IV. Provider business mailing address

1100 9TH AVE
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-842-5632
  • Fax: 206-842-5992
Mailing address:
  • Phone: 206-515-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60766323
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60889412
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: