Healthcare Provider Details

I. General information

NPI: 1982564779
Provider Name (Legal Business Name): MOKSHA WELLNESS THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 NE BOTHELL WAY FL 2
KENMORE WA
98028-8939
US

IV. Provider business mailing address

21412 50TH AVE W UNIT 8
MOUNTLAKE TERRACE WA
98043-3323
US

V. Phone/Fax

Practice location:
  • Phone: 206-414-9636
  • Fax:
Mailing address:
  • Phone: 206-414-9636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MS. RAJNI SAMYUKTHA KRISHNA
Title or Position: RDN
Credential: MA, RDN, LMHCA
Phone: 206-414-9636