Individual provider Active NPI

Patricia Anne Van Vactor, ARNP, FNP-C

  • Family Nurse Practitioner
  • Kirkland, WA
National Provider Identifier
1457027112
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP.AP.61148478-NP Issued in WA
Practice address
12423 Totem Lake Blvd NE
Kirkland, WA 98034-7504
Phone
(425) 406-5458
NPI assigned
Aug 20, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP.AP.61148478-NP WA Primary

Addresses

Primary practice location

12423 Totem Lake Blvd NE
Kirkland, WA 98034-7504

Mailing address

17550 156TH PL NE
Woodinville, WA 98072-9214
Phone (206) 818-9770

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211103002150 WA Practitioner - Nurse Practitioner 5294123600 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4220 132ND St SE
Suite 103
Mill Creek, WA 98012-8999
Phone (425) 899-5150

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP.AP.61148478-NPWAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Jul 31, 2021 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Jul 31, 2021 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Nov 1, 2022 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Nov 1, 2022 Accepting new patients
King County Public Hospital District No 2 Current Accepting new patients
King County Public Hospital District No 2 Current Accepting new patients

Locations

1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988

14720 Main St NE
Ste 109
Duvall, WA 98019
Phone (425) 788-4889

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

12039 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 899-3123

4220 132nd St SE
Ste 103
Mill Creek, WA 98012
Phone (425) 225-1210

8980 161st Ave NE
Ste 320
Redmond, WA 98052
Phone (425) 823-4000

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 7

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

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": "1629417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1457027112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17550 156TH PL NE",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980729214",
            "telephone_number": "206-818-9770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12423 TOTEM LAKE BLVD NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347504",
            "telephone_number": "425-406-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN VACTOR",
        "first_name": "PATRICIA",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "ARNP, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-20",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "ARNP.AP.61148478-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.