Basic Information
Provider Information
NPI: 1114325370
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BATEY
FirstName: KINDRA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11821 NE 128TH ST STE B
Address2:  
City: KIRKLAND
State: WA
PostalCode: 980347210
CountryCode: US
TelephoneNumber: 4258142800
FaxNumber: 4258230882
Practice Location
Address1: 11821 NE 128TH ST STE B
Address2:  
City: KIRKLAND
State: WA
PostalCode: 980347210
CountryCode: US
TelephoneNumber: 4258142800
FaxNumber: 4258230882
Other Information
ProviderEnumerationDate: 12/19/2014
LastUpdateDate: 12/19/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XMA60498215WAY Other Service ProvidersSpecialist 

No ID Information.


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