Healthcare Provider Details

I. General information

NPI: 1720175672
Provider Name (Legal Business Name): KITSAP CHILDRENS CLINIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SOUTH KITSAP BLVD SUITE 2300
PORT ORCHARD WA
98366
US

IV. Provider business mailing address

9951 MICKELBERRY RD NW SUITE 101
SILVERDALE WA
98383
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-0216
  • Fax: 360-895-7919
Mailing address:
  • Phone: 360-692-9362
  • Fax: 360-692-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: R BARNES VOEGTLEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 360-692-9362