Healthcare Provider Details

I. General information

NPI: 1811788771
Provider Name (Legal Business Name): KAILEY JAYCKLINE HICKEY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 YELM HWY SE
OLYMPIA WA
98501-4826
US

IV. Provider business mailing address

2612 YELM HWY SE
OLYMPIA WA
98501-4826
US

V. Phone/Fax

Practice location:
  • Phone: 360-507-8146
  • Fax: 360-839-2852
Mailing address:
  • Phone: 360-507-8146
  • Fax: 360-839-2852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP70043574
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: