KELLY MARIE KNICKERBOCKER (NPI# 1427304138) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427304138 |
| Entity Type | Individual |
| Full Name | KELLY MARIE KNICKERBOCKER |
| Credential | MSN RN PMHNP |
| Practice Address |
11411 Ne 124th St Suite 190 Kirkland WA 98034-4314 |
| Practice Telephone | 2816504154 |
| Practice Fax Number | 4258238235 |
| Mailing Telephone | 2069457512 |
| Mailing Fax Number | 4258238235 |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2020-08-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP 60448879 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
11411 NE 124TH ST SUITE 190 |
| City | KIRKLAND |
| State | WA |
| Zip Code | 98034-4314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851402622 | Susan Elizabeth Caverly | Registered Nurse | 11411 Ne 124th St, #190, Kirkland, WA 98034-4314 | 2006-08-31 |
| 1427159912 | Gail Rosenberg | Psychologist | 11411 Ne 124th St, Suite 190, Kirkland, WA 98034-4314 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578116596 | Rachel Bowers | Behavior Technician | 1335 Northeast 122nd Way, Suite 105, Kirkland, WA 98034 | 2019-07-18 |
| 1740841048 | Kristina Louise Inghram | Behavior Technician | 11415 Ne 128th St., Suite 40, Kirkland, WA 98034 | 2019-06-26 |
| 1053978064 | Matthew A. Bagnulo, Dds, Ps | Dentist | 11830 Ne 128th St., #202, Kirkland, WA 98034 | 2019-05-24 |
| 1629568928 | Stephanie Michalko | Optometrist | 11800 Ne 128th St Ste 110, Kirkland, WA 98034 | 2018-05-14 |
| 1952800013 | Heath Family Counseling LLC | Marriage & Family Therapist | 12025 115th Ave. Ne, Building D, Ste 200, Kirkland, WA 98034 | 2018-02-05 |
| 1891202834 | Barbara Josephine Gorham | Counselor | 2025 115th Ave Ne, Bldg D, #200, Kirkland, WA 98034 | 2017-12-29 |
| 1548782915 | Eleanor Hollis Wall | Counselor | 14340 102nd Ave Ne, Kirkland, WA 98034 | 2017-07-07 |
| 1457885212 | Peter Schoonmaker | Hospitalist | 12040 Ne 128th Street, Ms105, Kirkland, WA 98034 | 2017-04-18 |
| 1780124370 | Rebecca Managan | Advanced Practice Midwife | 12303 Ne 130th Ln Ste Coral225, Kirkland, WA 98034 | 2017-03-01 |
| 1669821104 | Winter Gonzalez | Counselor | 11720 97th Ln Ne Apt A411, Kirkland, WA 98034 | 2016-06-06 |
| Find all providers in zip 98034 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619376530 | Leilani De Jong | Nurse Practitioner | 5400 Carillon Pt Fl 4, Kirkland, WA 98033-7357 | 2014-08-15 |
| 1194898528 | Patricia Roth Wuertzer | Nurse Practitioner | 11411 Ne 124th St Ste 190, Kirkland, WA 98034-4318 | 2006-11-15 |
| 1609477538 | Copestone Psychiatric, LLC | Nurse Practitioner | 11335 Ne 122nd Way Ste 105, Kirkland, WA 98034-6933 | 2020-11-06 |
| 1710599758 | Kelly Knickerbocker Arnp Pllc | Nurse Practitioner | 11411 Ne 124th St Ste 190, Kirkland, WA 98034-4318 | 2020-08-20 |
| 1689224727 | Patricia Duenas Morgan | Nurse Practitioner | 12040 Ne 128th St, Kirkland, WA 98034-3013 | 2019-09-19 |
| 1902333644 | Ewa Kazimiera Kozlowska | Nurse Practitioner | 10200 Ne 132nd St, Kirkland, WA 98034 | 2017-05-12 |
| 1619403698 | Antonina Kozlowska | Nurse Practitioner | 10200 Ne 132nd St, Kirkland, WA 98034-2831 | 2017-05-11 |
| 1124337969 | Amy O. Zachara | Nurse Practitioner | 10200 Ne 132nd St, Kirkland, WA 98034-2831 | 2010-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1831799048 | Sarah Louise Weerheim | Nurse Practitioner | 2727 Hollycroft St Ste 110v, Gig Harbor, WA 98335-1371 | 2020-10-27 |
| 1619576774 | Bethany Heath Arnp-pmhnp Pllc | Nurse Practitioner | 1224 West Riverside, Apt 408, Spokane, WA 99201 | 2020-10-20 |
| 1437761988 | Hollye Hahn | Nurse Practitioner | 1012 Nw Longview Dr, Oak Harbor, WA 98277-8947 | 2020-08-17 |
| 1386254290 | Candie M. Wellwood | Nurse Practitioner | 9908 S Sherman Rd, Spokane, WA 99224-9811 | 2020-08-05 |
| 1104434679 | Progressive Psychiatric Consultant | Nurse Practitioner | 170 S Lincoln St # 150, Spokane, WA 99201-4443 | 2020-07-21 |
| 1235747213 | Peaceful Coexistence, LLC | Nurse Practitioner | 4730 University Way Ne Ste 104, Seattle, WA 98105-4424 | 2020-07-16 |
| 1134747066 | New Dawn Psychotherapy Pllc | Nurse Practitioner | 2223 Benson Rd S Apt D102, Renton, WA 98055-8837 | 2020-07-07 |
| 1376160861 | Clarity Behavioral Health | Nurse Practitioner | 7704 193rd Pl Sw, Edmonds, WA 98026-6234 | 2020-06-30 |
| 1174140677 | Rachael Davison | Nurse Practitioner | 22525 Se 64th Pl Ste 228, Issaquah, WA 98027-5383 | 2020-06-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.