Healthcare Provider Details

I. General information

NPI: 1396241071
Provider Name (Legal Business Name): KRISTEN GILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19200 N KELSEY ST
MONROE WA
98272-1431
US

IV. Provider business mailing address

PO BOX 31001-4110
PASADENA CA
91110-4114
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-7994
  • Fax:
Mailing address:
  • Phone: 360-794-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61541171
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: