Kelly Marie Knickerbocker, MSN ARNP PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP 60448879 Issued in WA

Practice address

16710 39TH Ave NE
Lake Forest Park, WA 98155

Phone

(425) 568-7608

Fax

(425) 669-3216

NPI assigned

Jul 31, 2012

Last updated

Jan 30, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Kelly Knickerbocker Arnp PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Kent, WA
  • NPI 1710599758
  NPD Authorized official

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

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1427304138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20126 BALLINGER WAY NE",
            "address_2": "89",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "98155",
            "telephone_number": "206-507-0666",
            "fax_number": "425-669-3216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16710 39TH AVE NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "98155",
            "telephone_number": "425-568-7608",
            "fax_number": "425-669-3216"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3510 Steelhammer Lane",
            "address_purpose": "LOCATION",
            "city": "Centralia",
            "state": "WA",
            "postal_code": "985311532",
            "country_code": "US",
            "telephone_number": "360-623-8020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20126 Ballinger Way NE # 89",
            "address_purpose": "LOCATION",
            "city": "Shoreline",
            "state": "WA",
            "postal_code": "981551117",
            "country_code": "US",
            "telephone_number": "425-568-7608",
            "fax_number": "425-669-3216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNICKERBOCKER",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "MSN ARNP PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-31",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP 60448879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATIONAL NPI 2",
            "identifier": "1710599158",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachael Johannah Katz, PCD, CLE
• Kelley Cares LLC
• Kent N Sullivan MD PLLC
• Niki Christine King
• Melinda Kloepfer Rice, ARNP
• Lake Forest Park Acupuncture and Massage
• Lake Forest Park Clinic TR (Lake Forest Park Medical Clinic)
• Lake Forest Vision
• Daisy Abutin Lalas, NURSE CASE MANAGER
• Rebecca Carolyn Langseth

• Psychiatric/Mental Health Nurse Practitioner in Lake Forest Park, WA
• Providers in Lake Forest Park, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2026; 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.