Individual
KELLY MARIE KNICKERBOCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN ARNP PMHNP
Contact information
Practice address
16710 39TH AVE NE, LAKE FOREST PARK, WA 98155
(425) 568-7608
(425) 669-3216
Mailing address
20126 BALLINGER WAY NE, 89, SHORELINE, WA 98155
(206) 507-0666
(425) 669-3216
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP 60448879
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710599158
ORGANIZATIONAL NPI 2
—
Enumeration date
07/31/2012
Last updated
01/30/2026
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