Basic Information
| Provider Information | |||||||||
| NPI: | 1831537943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINKLER | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | CORENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 AL ROBERTS RD | ||||||||
| Address2: | |||||||||
| City: | SENOIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302763556 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6505 216TH ST SW STE 100 | ||||||||
| Address2: | |||||||||
| City: | MOUNTLAKE TERRACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980432089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256407009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2013 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 041309380 | IL | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363L00000X | 209012592 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | AP60696757 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.