Healthcare Provider Details

I. General information

NPI: 1952265886
Provider Name (Legal Business Name): DILLON OWEN KENNISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W MARINE VIEW DR BLDG 2010
EVERETT WA
98207-5000
US

IV. Provider business mailing address

2000 W MARINE VIEW DR BLDG 2010
EVERETT WA
98207-5000
US

V. Phone/Fax

Practice location:
  • Phone: 425-304-4060
  • Fax: 425-304-4101
Mailing address:
  • Phone: 425-304-4060
  • Fax: 425-304-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95225183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: