Healthcare Provider Details

I. General information

NPI: 1902742984
Provider Name (Legal Business Name): EVERGREEN PSYCHIATRY AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 21ST ST SE
LAKE STEVENS WA
98258-3223
US

IV. Provider business mailing address

10123 21ST ST SE
LAKE STEVENS WA
98258-3223
US

V. Phone/Fax

Practice location:
  • Phone: 206-422-7742
  • Fax: 206-422-7742
Mailing address:
  • Phone: 206-422-7742
  • Fax: 206-422-7742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AGNES WANJIKU MBATIA
Title or Position: PROVIDER
Credential: NP
Phone: 206-422-7742