Provider Demographics
NPI:1437213485
Name:HEUSTED, KARIN P (ARNP)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:P
Last Name:HEUSTED
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:
Other - Last Name:WARACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22722 29TH DR. SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021
Mailing Address - Country:US
Mailing Address - Phone:425-780-9168
Mailing Address - Fax:855-710-7965
Practice Address - Street 1:2609 183RD ST. SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-761-3792
Practice Address - Fax:855-710-7965
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0205101OtherLABOR AND INDUSTRIES
WA9643198Medicaid
WA0205101OtherLABOR AND INDUSTRIES
WA9643198Medicaid