Healthcare Provider Details

I. General information

NPI: 1699292599
Provider Name (Legal Business Name): KRISTA T NUGENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31620 23RD AVE S STE 302
FEDERAL WAY WA
98003-5064
US

IV. Provider business mailing address

10835 SE KENT KANGLEY RD APT F5
KENT WA
98030-7773
US

V. Phone/Fax

Practice location:
  • Phone: 206-592-2756
  • Fax:
Mailing address:
  • Phone: 845-421-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: