Provider Demographics
NPI:1366131104
Name:ORTH SUND, KRYSTAL MERCEDES (ARNP)
Entity type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:MERCEDES
Last Name:ORTH SUND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:MERCEDES
Other - Last Name:ORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22000 MARINE VIEW DR S STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6233
Mailing Address - Country:US
Mailing Address - Phone:206-592-5960
Mailing Address - Fax:
Practice Address - Street 1:22000 MARINE VIEW DR S STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6233
Practice Address - Country:US
Practice Address - Phone:206-592-5960
Practice Address - Fax:206-870-4770
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61578644363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner