Kelly Knickerbocker Arnp PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

KELLY KNICKERBOCKER ARNP PLLC

Practice address

10802 SE Kent Kangley Rd
Suite 103
Kent, WA 98030

Phone

(206) 507-0666

NPI assigned

Aug 20, 2020

Last updated

Sep 18, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly Knickerbocker, MSN ARNP PMHNPNPI 1427304138

Title

Owner

Phone

(206) 507-0666

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kelly Knickerbocker ARNP Former legal business name

Locations

Practitioners 5

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.

• Kelly Marie Knickerbocker, MSN ARNP PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Lake Forest Park, WA
  • NPI 1427304138
  NPD Authorized official
• Gail Rosenberg, PH.D.

  • Psychologist
  • Kirkland, WA
  • NPI 1427159912
  NPD
• Susan Elizabeth Caverly, PHD,ARNP,MA,BC

  • Psychiatric/Mental Health Registered Nurse
  • Chelan, WA
  • NPI 1851402622
  NPD (past)
• Lynne A Wilk, MD

  • Psychiatry Physician
  • Kirkland, WA
  • NPI 1790903318
  NPD (past)
• Patricia Roth Wuertzer, A.R.N.P.

  • Psychiatric/Mental Health Nurse Practitioner
  • Kirkland, WA
  • NPI 1194898528
  NPD (past)

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

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789689600000",
    "number": "1710599758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10802 SE KENT KANGLEY RD",
            "address_2": "#103",
            "city": "KENT",
            "state": "WA",
            "postal_code": "98030",
            "telephone_number": "206-507-0666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10802 SE KENT KANGLEY RD",
            "address_2": "SUITE 103",
            "city": "KENT",
            "state": "WA",
            "postal_code": "98030",
            "telephone_number": "206-507-0666"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10802 SE Kent Kangley Rd",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Kent",
            "state": "WA",
            "postal_code": "98030",
            "country_code": "US",
            "telephone_number": "206-507-0666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KELLY KNICKERBOCKER ARNP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-20",
        "last_updated": "2026-09-18",
        "certification_date": "2026-09-17",
        "status": "A",
        "authorized_official_last_name": "KNICKERBOCKER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-507-0666",
        "authorized_official_credential": "MSN ARNP PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI (NPI 1)",
            "identifier": "1427304138",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelly Knickerbocker ARNP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Mary Elliott Keane
• Maryam Keikhosro-Kiani, DMD
• Jessica Kellam
• Melanie S. Keller, LMP
• Kamryn Kellogg
• Devan Kelso, LMP
• June Kemboi
• Jaime Jozwiak Kemery
• Katie Jeane Kemp, L.M.P.
• Elizabeth Anne Kempkes, LMP

• Psychiatric/Mental Health Nurse Practitioner in Kent, WA
• Providers in Kent, 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 Sep 18, 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.