Healthcare Provider Details

I. General information

NPI: 1801704473
Provider Name (Legal Business Name): KRISTY ANN WALLER PHD RN BC-FHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 DISCOVERY CIR NE UNIT 103
ISSAQUAH WA
98029-6223
US

IV. Provider business mailing address

IN C/O DAVE JOHNSON 620 N. COLES LOOP
POST FALLS ID
83854
US

V. Phone/Fax

Practice location:
  • Phone: 208-252-5256
  • Fax:
Mailing address:
  • Phone: 208-252-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberN-25844
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: