Healthcare Provider Details

I. General information

NPI: 1467156992
Provider Name (Legal Business Name): SAM MATHEW ARNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10634 E RIVERSIDE DR STE 130
BOTHELL WA
98011-3758
US

IV. Provider business mailing address

3015 182ND PL SE
BOTHELL WA
98012-6084
US

V. Phone/Fax

Practice location:
  • Phone: 425-677-4613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61421720
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: