Healthcare Provider Details

I. General information

NPI: 1437213485
Provider Name (Legal Business Name): KARIN P HEUSTED ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARIN WARACK

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 183RD ST. SE
BOTHELL WA
98012
US

IV. Provider business mailing address

22722 29TH DR. SE SUITE 100
BOTHELL WA
98021
US

V. Phone/Fax

Practice location:
  • Phone: 425-761-3792
  • Fax: 855-710-7965
Mailing address:
  • Phone: 425-780-9168
  • Fax: 855-710-7965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30005606
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0205101
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerLABOR AND INDUSTRIES
# 2
Identifier9643198
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: