Healthcare Provider Details

I. General information

NPI: 1568846558
Provider Name (Legal Business Name): KELLI KRAFT MN, ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 RIDDLE STREET
DARRINGTON WA
98241-9824
US

IV. Provider business mailing address

1400 E. KINCAID STREET ATTN: CREDENTIALING
MOUNT VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-436-1055
  • Fax: 360-436-0146
Mailing address:
  • Phone: 360-814-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number991572
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60673672
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60673672
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: