Provider Demographics
NPI:1063440964
Name:MOORE, TAMMY H (ARNP)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:H
Last Name:MOORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:HOPE
Other - Last Name:BARWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541
Mailing Address - Country:US
Mailing Address - Phone:360-495-3244
Mailing Address - Fax:360-495-3364
Practice Address - Street 1:600 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541
Practice Address - Country:US
Practice Address - Phone:360-495-3244
Practice Address - Fax:360-495-3364
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006758363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9644014OtherDSHS#
WA1090710Medicaid
WA0159113OtherLABOR AND INDUSTRIES#
WAMD1136313OtherDEA#
WA1090710Medicaid
WA9644014OtherDSHS#
WAG8887258Medicare PIN