Healthcare Provider Details

I. General information

NPI: 1770305898
Provider Name (Legal Business Name): MERRYMAN PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 216TH PL SE
BOTHELL WA
98021-7980
US

IV. Provider business mailing address

4403 216TH PL SE
BOTHELL WA
98021-7980
US

V. Phone/Fax

Practice location:
  • Phone: 206-595-2138
  • Fax:
Mailing address:
  • Phone: 206-595-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHRIS MERRYMAN
Title or Position: PROVIDER/OWNER
Credential: PA C
Phone: 206-595-2138