Healthcare Provider Details

I. General information

NPI: 1306761952
Provider Name (Legal Business Name): DEVIN L MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SW 148TH ST
BURIEN WA
98166-1835
US

IV. Provider business mailing address

19020 131ST AVE SE
RENTON WA
98058-7934
US

V. Phone/Fax

Practice location:
  • Phone: 206-971-8830
  • Fax:
Mailing address:
  • Phone: 425-365-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: