Healthcare Provider Details

I. General information

NPI: 1497530604
Provider Name (Legal Business Name): KRISTINA DIANE BLUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32114 1ST AVE S STE 203
FEDERAL WAY WA
98003-5760
US

IV. Provider business mailing address

19619 SE 264TH CT
COVINGTON WA
98042-5034
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-0219
  • Fax:
Mailing address:
  • Phone: 253-880-5563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberARNP.AP.70157888-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: