Individual provider Active NPI

Kaitlin Huennekens, MD

  • Family Medicine Physician
  • Everett, WA
National Provider Identifier
1104344928
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
61465517 Issued in WA
Practice address
1019 112TH St SW
Everett, WA 98204-4875
Phone
(425) 789-3789
NPI assigned
Aug 31, 2017
Last updated
Sep 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 61465517 WA Primary

Addresses

Primary practice location

1019 112TH St SW
Everett, WA 98204-4875

Mailing address

1019 112TH St SW
Everett, WA 98204-4875
Phone (425) 789-3789

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250801003133 WA Practitioner - Family PracticePractitioner - Addiction Medicine 6406224112 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Addiction Medicine
Education
Northwestern University Feinberg Medical School, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedish Health ServicesGroup PAC ID 0244138196, 1,038 clinicians

Practice addresses (Care Compare)

1019 112TH St SW
Everett, WA 98204-4875
Phone (425) 551-6200

1801 NW Market St
Suite 207
Seattle, WA 98107-3909
Phone (206) 386-6600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
61465517WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center of Snohomish County CurrentSince Jan 5, 2026 Accepting new patients
Swedish Health Services CurrentSince Jul 13, 2025 Accepting new patients
Community Health Center of Snohomish County Family Medicine CurrentSince Jan 5, 2026 Accepting new patients
Providence Health & Services-Wa Past Accepting new patients

Locations

7320 216th St SW
Ste 310
Edmonds, WA 98026
Phone (425) 673-3800

1019 112th St SW
Everett, WA 98204
Phone (425) 551-6001

1801 Lind Ave SW
Renton, WA 98057

1401 Madison St
Ste 100
Seattle, WA 98104
Phone (206) 386-6111

1801 NW Market St
Ste 207
Seattle, WA 98107
Phone (206) 320-7330

747 Broadway
Seattle, WA 98122
Phone (360) 658-2488

Interoperability endpoints

  • Direct secure messaging: khuennekens1717409@wm.providencedirect.org
  • Direct secure messaging: khuennekens840542@direct.ochin.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1104344928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 112TH ST SW",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982044875",
            "telephone_number": "425-789-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 112TH ST SW",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982044875",
            "telephone_number": "425-789-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUENNEKENS",
        "first_name": "KAITLIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-31",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "61465517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.