Healthcare Provider Details

I. General information

NPI: 1699273375
Provider Name (Legal Business Name): CHRISTINA LYN PRATT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA BROUGHTON

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E KINCAID ST
MOUNT VERNON WA
98274-4127
US

IV. Provider business mailing address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-2550
  • Fax:
Mailing address:
  • Phone: 360-428-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61127411
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: