Doctor Name: | KEYA CHISHOLM |
NPI Number: | 1083942114 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | AP60122496 |
Business Practice Address: | 450 Nw Gilman Blvd Suite 201 Issaquah, WA - 980272483 |
Business Phone Number: | 4253910705 |
Business Fax Number: | 4253919562 |
Mailing Address: | 450 Nw Gilman Blvd, Suite 201 ISSAQUAH |
State: | WA |
Postal Code: | 980272483 |
Phone Number: | 4253910705 |
Fax Number: | 4253919562 |
NPI Enumeration Date: | 12/01/2009 |
NPI Last Update Date: | 12/01/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP60122496 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |