Healthcare Provider Details

I. General information

NPI: 1982778650
Provider Name (Legal Business Name): KITSAP CHILDRENS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 MICKELBERRY RD NW SUITE 101
SILVERDALE WA
98383
US

IV. Provider business mailing address

9951 MICKELBERRY RD NW SUITE 101
SILVERDALE WA
98383
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-9362
  • Fax: 360-692-6214
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: BARNEY RUSSEL VOEGTLEN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 360-692-9362