Provider Demographics
NPI:1538627468
Name:SHULL, KAYLA R (ARNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:SHULL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 NAGLE PL APT 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2447
Mailing Address - Country:US
Mailing Address - Phone:808-840-7550
Mailing Address - Fax:
Practice Address - Street 1:505 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5709
Practice Address - Country:US
Practice Address - Phone:253-833-7444
Practice Address - Fax:253-661-8644
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60866729163W00000X
WAAP61217782363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602405676OtherPREMERA