Healthcare Provider Details

I. General information

NPI: 1083238745
Provider Name (Legal Business Name): KATHERINE ROSE WIKEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE EVERED

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 NE 130TH LANE, CORAL 500
KIRKLAND WA
98034
US

IV. Provider business mailing address

12303 NE 130TH LN STE 500
KIRKLAND WA
98034-3059
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-4280
  • Fax: 425-899-4294
Mailing address:
  • Phone: 425-899-4280
  • Fax: 425-899-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61177342
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60756278
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: