Basic Information
| Provider Information | |||||||||
| NPI: | 1699203620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | TIFFANY | ||||||||
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| Credential: | CNP, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6505 216TH ST SW | ||||||||
| Address2: | STE 100 | ||||||||
| City: | MOUNTLAKE TERRACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980432089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256407009 | ||||||||
| FaxNumber: | 4256786455 | ||||||||
| Practice Location | |||||||||
| Address1: | 2004 HOSPITAL WAY | ||||||||
| Address2: | |||||||||
| City: | WHITEFISH | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599377858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068621030 | ||||||||
| FaxNumber: | 4068621056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2017 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP61108293 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | RN379400 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.