Healthcare Provider Details

I. General information

NPI: 1982478681
Provider Name (Legal Business Name): KAYLEEN MERIAM HEAGNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 136TH PL NE
BELLEVUE WA
98005-2343
US

IV. Provider business mailing address

1800 136TH PL NE
BELLEVUE WA
98005-2343
US

V. Phone/Fax

Practice location:
  • Phone: 253-223-3163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN60690219
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60690219
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: