Healthcare Provider Details

I. General information

NPI: 1013916139
Provider Name (Legal Business Name): KENNETH C PLITT RN, ARNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 SUNROSE PL SE
MILL CREEK WA
98012-1391
US

IV. Provider business mailing address

PO BOX 2329
MOUNT VERNON WA
98273-7329
US

V. Phone/Fax

Practice location:
  • Phone: 425-743-9849
  • Fax:
Mailing address:
  • Phone: 360-336-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00124687
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30004670
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: