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NPI Code Detail

MEDICARE: ALYSSA POGHEN DNP, AG-ACNP

MEDICARE: ALYSSA POGHEN DNP, AG-ACNP
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
1363LA2100XAcute Care Nurse PractitionerAP61186875WA
2163WC0200XCritical Care Medicine Registered NurseRN60600430WA

General Provider Information

NPI Number : 1942813878
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA POGHEN DNP, AG-ACNP
Provider Business Mailing Address
First Line : 23920 229TH PL SE
Second Line :
City : MAPLE VALLEY
State : WA
Zip : 98038-5051
Country : US
Telephone Number : 206-830-8729
Fax Number :
Provider Business Practice Location Address
First Line : 5520 BRIDGEPORT WAY W
Second Line :
City : UNIVERSITY PLACE
State : WA
Zip : 98467-2041
Country : US
Telephone Number : 253-566-7166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2020
Last Update Date : 04/01/2026

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