MEDICARE: PROACTIVE HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043177835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE HEALTH PLLC

Provider Business Mailing Address
First Line	:	1 E 5TH ST STE 150
Second Line	:
City	:	WENATCHEE
State	:	WA
Zip	:	98801-6649
Country	:	US
Telephone Number	:	509-436-1137
Fax Number	:	509-436-1148

Provider Business Practice Location Address
First Line	:	1 E 5TH ST STE 150
Second Line	:
City	:	WENATCHEE
State	:	WA
Zip	:	98801-6649
Country	:	US
Telephone Number	:	509-436-1137
Fax Number	:	509-436-1148

Authorized Official
Title or Position	:	OWNER
Name	:	TYLER ALLEN SHERMAN
Credential	:	DO
Telephone Number	:	435-531-3923

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	06/03/2026

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