Provider Demographics
NPI:1053194134
Name:PLATT, BAILEY NICOLE (ARNP)
Entity type:Individual
Prefix:
First Name:BAILEY NICOLE
Middle Name:
Last Name:PLATT
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 1:17930 TALBOT RD S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6230
Mailing Address - Country:US
Mailing Address - Phone:425-228-3187
Mailing Address - Fax:425-228-7972
Practice Address - Street 1:17930 TALBOT RD S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6230
Practice Address - Country:US
Practice Address - Phone:425-228-3187
Practice Address - Fax:425-228-7972
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60739758163W00000X
WAAP61488335363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2261540Medicaid