Provider Demographics
NPI:1235978990
Name:FRIAS, KAILYN CHRISTINE (RN)
Entity type:Individual
Prefix:
First Name:KAILYN
Middle Name:CHRISTINE
Last Name:FRIAS
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:KAILYN
Other - Middle Name:CHRISTINE
Other - Last Name:FRIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:425-312-0204
Mailing Address - Fax:
Practice Address - Street 1:1920 100TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-312-0204
Practice Address - Fax:425-312-0263
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0135134171M00000X
WARN61477945171M00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2290061Medicaid