Healthcare Provider Details

I. General information

NPI: 1972977924
Provider Name (Legal Business Name): PENINSULA COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 ALMIRA DR NE
BREMERTON WA
98311-8330
US

IV. Provider business mailing address

PO BOX 960
BREMERTON WA
98337-0212
US

V. Phone/Fax

Practice location:
  • Phone: 360-377-3776
  • Fax:
Mailing address:
  • Phone: 360-377-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KREIDLER-MOSS
Title or Position: CEO
Credential:
Phone: 360-377-3776