Healthcare Provider Details

I. General information

NPI: 1508463902
Provider Name (Legal Business Name): AMY KALISEK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 CAROLINE ST
PORT ANGELES WA
98362-3997
US

IV. Provider business mailing address

221 BERTHOUD WAY
GOLDEN CO
80401-4813
US

V. Phone/Fax

Practice location:
  • Phone: 360-417-7000
  • Fax:
Mailing address:
  • Phone: 281-650-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0995589-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61112885
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: