Provider Demographics
NPI:1578374740
Name:DERESSE, KEDEST (RN)
Entity type:Individual
Prefix:
First Name:KEDEST
Middle Name:
Last Name:DERESSE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16804 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4961
Mailing Address - Country:US
Mailing Address - Phone:206-245-0358
Mailing Address - Fax:
Practice Address - Street 1:16804 1ST AVE W
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-4961
Practice Address - Country:US
Practice Address - Phone:206-245-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60264424163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse