KELLY MARIE KNICKERBOCKER MSN ARNP PMHNP
NPI 1427304138
Nurse Practitioner - Psychiatric/Mental Health in Lake Forest Park, WA

Q: What is Kelly Knickerbocker's NPI number?

The NPI number for Kelly Knickerbocker is 1427304138. It was assigned to this individual provider in the NPPES registry on July 31, 2012.

Q: What is Kelly Knickerbocker's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Active since July 31, 2012

16710 39TH AVE NE, LAKE FOREST PARK, WA 98155(425) 568-7608(425) 669-3216 Get Directions Write a Review

NPPES record last updated: January 30, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 30, 2026, Dec 7, 2023, Aug 12, 2020 and 2 more (5 updates tracked since 2016).

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About Kelly Marie Knickerbocker Msn Arnp Pmhnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY MARIE KNICKERBOCKER MSN ARNP PMHNP (NPI 1427304138) is an individual psychiatric/mental health provider in Lake Forest Park, Washington, licensed in Washington (AP 60448879) and active in the NPI registry since July 2012. She maintains 2 additional practice locations.

NPPES Registry Identity

NPI1427304138

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameKELLY MARIE KNICKERBOCKERCredential: MSN ARNP PMHNP

Location Address16710 39TH AVE NELake Forest Park, WA 98155

Mailing Address20126 Ballinger Way Ne, 89Shoreline, WA 98155 · (206) 507-0666 · Fax (425) 669-3216

Phone(425) 568-7608

Fax(425) 669-3216

Sole ProprietorYes

Enumeration DateJuly 31, 2012

Last NPPES UpdateJanuary 30, 20265 updates tracked since enumeration

NPPES CertifiedJanuary 30, 2026

✔ NPI 1427304138 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in WA · AP 60448879

16710 39TH AVE NE, Lake Forest Park, WA 98155

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Secondary Practice Locations 2

Location 120126 Ballinger Way NE # 89Shoreline, WA 98155-1117 · Phone (425) 568-7608 · Fax (425) 669-3216

Location 23510 Steelhammer LaneCentralia, WA 98531-1532 · Phone (360) 623-8020

Other Identifiers 1

Other1710599158Organizational Npi 2

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska.Insurance ›

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Knickerbocker's NPI number?

The NPI number for Kelly Knickerbocker is 1427304138. It was assigned to this individual provider in the NPPES registry on July 31, 2012.

Where is Kelly Knickerbocker located?

Kelly Knickerbocker practices at 16710 39th Ave NE, Lake Forest Park, WA 98155. The listed phone number is (425) 568-7608.

What is Kelly Knickerbocker's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

What insurance does Kelly Knickerbocker accept?

Health plans from PacificSource Health Plans and Premera Blue Cross Blue Shield of Alaska list Kelly Knickerbocker as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Knickerbocker was last updated on January 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.