Healthcare Provider Details

I. General information

NPI: 1861312605
Provider Name (Legal Business Name): TETYANA DEREPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TETYANA DOVMAT

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13824 SE 251ST ST
KENT WA
98042-6629
US

IV. Provider business mailing address

13824 SE 251ST ST
KENT WA
98042-6629
US

V. Phone/Fax

Practice location:
  • Phone: 425-443-4007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: