=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801704473
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTY ANN WALLER PHD RN BC-FHS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2026
-----------------------------------------------------
Last Update Date | 09/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 967 DISCOVERY CIR NE UNIT 103
-----------------------------------------------------
City | ISSAQUAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98029-6223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-252-5256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | IN C/O DAVE JOHNSON 620 N. COLES LOOP
-----------------------------------------------------
City | POST FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-252-5256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | N-25844
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------