Healthcare Provider Details

I. General information

NPI: 1205741295
Provider Name (Legal Business Name): NIGHTINGALE DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19987 1ST AVE S STE 103
NORMANDY PARK WA
98148-2400
US

IV. Provider business mailing address

17837 1ST AVE S # 156
NORMANDY PARK WA
98148-1728
US

V. Phone/Fax

Practice location:
  • Phone: 206-929-4707
  • Fax:
Mailing address:
  • Phone: 206-929-4707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATIE HAYES
Title or Position: OWNER
Credential: ARNP
Phone: 206-650-9453