Provider Demographics
NPI:1386129609
Name:STORY, MISTY LYNN (ND)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:LYNN
Last Name:STORY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 N DRIVER LN APT 117
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-0012
Mailing Address - Country:US
Mailing Address - Phone:303-518-2202
Mailing Address - Fax:
Practice Address - Street 1:5600 14TH AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3723
Practice Address - Country:US
Practice Address - Phone:206-919-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0040175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0040OtherNATUROPATHIC PHYSICIAN LICENSURE
WANT61654644OtherNATUROPATHIC PHYSICIAN LICENSE