Healthcare Provider Details

I. General information

NPI: 1477417889
Provider Name (Legal Business Name): AGNES MBATIA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21907 64TH AVE W STE 200
MOUNTLAKE TERRACE WA
98043-6200
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 425-578-5144
  • Fax:
Mailing address:
  • Phone: 206-422-7742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70075749
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: