Lisa Cathleen Kieneker, MD
Individual provider Active NPI Family Medicine Physician · La Conner, WA
NPI 1215422928 · NPPES record last updated Jul 8, 2026
Key facts
- NPI
- 1215422928
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD61130841 (WA)
- Practice address
- 528 Myrtle St
La Conner, WA 98257 - Phone
- (360) 466-0107
- NPI assigned
- Jun 25, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 27
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Grant County Public Hospital District 1
Select Outpatient Services Inc
Select Rehabilitation, LLC
Optum Care Washington PLLC
Practice addresses (Care Compare)
1550 S Pioneer Way
Suite 115
Moses Lake, WA 98837-4618
2600 Compass Rd
Glenview, IL 60026-8001
3901 Hoyt Ave
Everett, WA 98201-4918
Phone (425) 339-5442
Hospital & facility affiliations
- Island Hospital
- Skagit Valley Hospital
- Samaritan Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210729003108 | WA | Practitioner - Family Practice | 7719235480 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD61130841 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Polyclinic PLLC | Family Medicine | Current | Accepting new patients |
| The Polyclinic PLLC | Family Medicine | Current |
Accepting new patients |
| Optum Care Washington PLLC | Current |
Accepting new patients | |
| Optum Care Washington PLLC | Family Medicine | Current | Accepting new patients |
| Optum Care Washington PLLC | Family Medicine | Current |
Accepting new patients |
| Optum Care Washington PLLC | Past | Accepting new patients | |
| Grant County Public Hospital District 1 | Family Medicine | Past |
Accepting new patients |
Locations
3901 Hoyt Ave
Everett, WA 98201
Phone (425) 258-3903
1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903
1145 Broadway
Seattle, WA 98122
904 7th Ave
Seattle, WA 98104
Phone (206) 223-6487
1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299
1812 S J St
Ste 102
Tacoma, WA 98405
Phone (253) 552-4900
Interoperability endpoints
- lkieneker1754151@wm.providencedirect.org
- lkieneker100564@direct.tecmc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | TRN27403 | FL | |
| Family Medicine Physician | 207Q00000X | MD61130841 | WA | Yes |
Addresses
Primary practice location
528 Myrtle St
La Conner, WA 98257
Mailing address
7600 Evergreen Way
Everett, WA 98203-6421
Phone (206) 860-5414
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2179902 | Medicaid | WA |
Other providers in La Conner, WA
- John K Fischer DDS PS
- David Michael Johnson
- Laura Lynne Kasayuli
- Latoya Evangelyn Kaubin
- Whitney Ingrid Will Keith
- Marcus Eric Kuypers
- La Conner Drug Store
- La Conner Health and Wellness LLC
- La Conner School District
- Charles Evert Larsson
All providers in La Conner, WA · Family Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.