MEDICARE: BROCK ALAN WOOTEN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0036699	OH
2	363L00000X	Nurse Practitioner	AP70035795	WA

General Provider Information

NPI Number	:	1659116408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROCK ALAN WOOTEN

Provider Business Mailing Address
First Line	:	2111 N NORTHGATE WAY STE 216
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-9018
Country	:	US
Telephone Number	:	206-385-9636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 N NORTHGATE WAY STE 216
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-9018
Country	:	US
Telephone Number	:	206-385-9636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	01/08/2026

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Directions to “ BROCK ALAN WOOTEN ” Practice Location

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