Healthcare Provider Details

I. General information

NPI: 1952320731
Provider Name (Legal Business Name): KRISTA D CALDWELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA D DICKEY

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 16TH AVE E
SEATTLE WA
98112-5226
US

IV. Provider business mailing address

201 16TH AVE E
SEATTLE WA
98112-5226
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-3000
  • Fax: 206-326-2785
Mailing address:
  • Phone: 206-326-3000
  • Fax: 206-326-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD601898604
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberM3951
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberM3951
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMD60189604
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: