Healthcare Provider Details

I. General information

NPI: 1154710119
Provider Name (Legal Business Name): KIRSTEN MARIE BAYNE CPO, NRP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 5TH ST SE STE 1700
PUYALLUP WA
98372-4602
US

IV. Provider business mailing address

1450 5TH ST SE STE 1700
PUYALLUP WA
98372-4602
US

V. Phone/Fax

Practice location:
  • Phone: 253-840-0227
  • Fax: 253-840-1176
Mailing address:
  • Phone: 253-840-0227
  • Fax: 253-840-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number208354
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number139964
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOI 60474160
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS60564404
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: