1952903510 NPI number — KATLYN ELIZABETH SARGENT SHEETS ARNP

Table of content: KATLYN ELIZABETH SARGENT SHEETS ARNP (NPI 1952903510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952903510 NPI number — KATLYN ELIZABETH SARGENT SHEETS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARGENT SHEETS
Provider First Name:
KATLYN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SARGENT
Provider Other First Name:
KATLYN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952903510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 WHEATON WAY STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98310-4459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-621-2696
Provider Business Mailing Address Fax Number:
844-602-4646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 WHEATON WAY STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98310-4459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-621-2696
Provider Business Practice Location Address Fax Number:
844-602-4646
Provider Enumeration Date:
11/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP61228185 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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