Provider Demographics
NPI:1699292599
Name:NUGENT, KRISTA T
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:T
Last Name:NUGENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10835 SE KENT KANGLEY RD APT F5
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7773
Mailing Address - Country:US
Mailing Address - Phone:845-421-2081
Mailing Address - Fax:
Practice Address - Street 1:31620 23RD AVE S STE 302
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5064
Practice Address - Country:US
Practice Address - Phone:206-592-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1980028Medicaid