Kristin A Park, DNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP60491879 Issued in WA

Practice address

17700 SE 272ND St # 400
Covington, WA 98042-4951

Phone

(253) 372-6512

Fax

(253) 372-6527

NPI assigned

Sep 22, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Multicare Health System

  • Neurological Surgery Physician
  • Tacoma, WA
  • NPI 1497766638
  Medicare reassignment NPD
• Multicare Health System

  • Pediatrics Physician
  • Gig Harbor, WA
  • NPI 1225674963
  NPD
• Multicare Health System

  • Family Medicine Physician
  • Auburn, WA
  • NPI 1013969195
  NPD (past)

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676937600000",
    "number": "1558763516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10863 SE 218TH PL",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980311373",
            "telephone_number": "253-307-9681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17700 SE 272ND ST # 400",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980424951",
            "telephone_number": "253-372-6512",
            "fax_number": "253-372-6527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KRISTIN",
        "middle_name": "A",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-22",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "814227",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60491879",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "AP60491879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Gabrielle Paige
• Turen Pang
• Andrew Park, D.P.M.
• Christopher Jin Park, D.D.S.
• Hyun Jin Park, PHARMD
• Elizabeth Parkhurst, DPT
• Jonathan Hugh Parks
• Caleb Pate
• Pearson Chiropractic PLLC
• Jay Scott Pearson, DC

• Pediatric Nurse Practitioner in Covington, WA
• Providers in Covington, WA by specialty
• Pediatric Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.