NPIMap

Organization Active NPI

Premier Diabetes Care, PLLC

  • Adult Health Nurse Practitioner
  • Arlington, WA
National Provider Identifier
1235696568
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
PREMIER DIABETES CARE, PLLC
Practice address
16404 Smokey Point Blvd
Suite 102
Arlington, WA 98223
Phone
(425) 318-7144
Fax
(425) 748-7378
NPI assigned
Feb 22, 2019
Last updated
Jul 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Authorized official

Name
Kay Lee Moua, ARNP
Title
President/Owner
Phone
(425) 344-0929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X NU Primary

Addresses

Primary practice location

16404 Smokey Point Blvd
Suite 102
Arlington, WA 98223

Mailing address

16404 Smokey Point Blvd
Suite 102
Arlington, WA 98223
Phone (425) 318-7144

Other identifiers 3

IdentifierTypeStateIssuer
1235696568OtherWANPI
G8995537OtherWAMEDICARE
2125115MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@premierdiabetescare.com Direct

National Provider Directory

National Provider Directory

Locations

16404 Smokey Point Blvd
Ste 102
Arlington, WA 98223
Phone (360) 420-9488

111 SE Everett Mall Way
Ste E103
Everett, WA 98208
Phone (425) 318-7144

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1550793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1235696568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16404 SMOKEY POINT BLVD",
            "address_2": "SUITE 102",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "98223",
            "telephone_number": "425-318-7144",
            "fax_number": "425-748-7378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16404 SMOKEY POINT BLVD",
            "address_2": "SUITE 102",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "98223",
            "telephone_number": "425-318-7144",
            "fax_number": "425-748-7378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DIABETES CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-22",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "MOUA",
        "authorized_official_first_name": "KAY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "425-344-0929",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1235696568",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G8995537",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2125115",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@premierdiabetescare.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "16404 Smokey Point Blvd",
            "address_2": "Suite 102",
            "city": "Arlington",
            "state": "WA",
            "country_code": "US",
            "postal_code": "98223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Arlington, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.