Healthcare Provider Details

I. General information

NPI: 1073027942
Provider Name (Legal Business Name): KRYSTA ROSE CARRICK BYRNES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTA ROSE CARICK DNP

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 2ND AVE STE 200
SEATTLE WA
98121-1495
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61052022
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number147513
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61052022
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number147512
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN60378121
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN60378121
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN60378121
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: