Healthcare Provider Details

I. General information

NPI: 1124951926
Provider Name (Legal Business Name): KIM NOELLE CRISTION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N 5TH AVE
SEQUIM WA
98382-3045
US

IV. Provider business mailing address

40 YELLOW ROCK LN
PORT ANGELES WA
98362-9395
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-5900
  • Fax: 360-582-4800
Mailing address:
  • Phone: 360-683-5900
  • Fax: 360-582-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN60297468
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: