| NPI | 1710599758 |
|---|---|
| Former Legal Business Name | KELLY KNICKERBOCKER ARNP |
| Entity Type | Organization |
| Authorized Contact | DAVID SWANSON Administrator 425-954-3330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2023-12-07 |