1275573693 NPI number — MRS. TRISTA L DARLING DC

Table of content: MRS. TRISTA L DARLING DC (NPI 1275573693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275573693 NPI number — MRS. TRISTA L DARLING DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARLING
Provider First Name:
TRISTA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275573693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
327 NE 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMAS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98607-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-834-5126
Provider Business Mailing Address Fax Number:
360-838-1582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 NE 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMAS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98607-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-834-5126
Provider Business Practice Location Address Fax Number:
360-834-5126
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00034505 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 138359 . This is a "KAISER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0200616 . This is a "WASHINGTON L&I PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 885134002 . This is a "REGENCE OF OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 8434722 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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