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General NPI Number Information
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NPI Number | 1003952870
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Entity Type | Individual
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Provider Name | KRISTEN M CHILDRESS ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 2431 ANDERSON AVE
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City | PORT ORCHARD
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State | WA
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Zip | 98366-1302
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Country | US
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Telephone | 360-710-3319
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Fax | 360-876-0878
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Provider Business Mailing Address
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Address Line | 4810 POINT FOSDICK DR NW PMB 27
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City | GIG HARBOR
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State | WA
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Zip | 98335-1711
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Country | US
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Telephone | 360-710-3319
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Fax | 360-876-0878
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN00138087
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP30006700
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License Number State | WA
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