Healthcare Provider Details

I. General information

NPI: 1306293337
Provider Name (Legal Business Name): KRISTIN LOUISE WILCOX CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN LOUISE WOODWORTH CNP

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 13TH ST STE 210
EVERETT WA
98201-1621
US

IV. Provider business mailing address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 425-297-5660
  • Fax: 425-297-5505
Mailing address:
  • Phone: 614-293-3196
  • Fax: 614-293-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number382858
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number019456
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP61013991
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: