Healthcare Provider Details

I. General information

NPI: 1639097678
Provider Name (Legal Business Name): KENDRA MOODY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 148TH ST SE STE 203
BOTHELL WA
98012-4752
US

IV. Provider business mailing address

10818 202ND AVE SE
SNOHOMISH WA
98290-3642
US

V. Phone/Fax

Practice location:
  • Phone: 425-225-5310
  • Fax:
Mailing address:
  • Phone: 425-290-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP.AP.70147520-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: