Healthcare Provider Details

I. General information

NPI: 1487317939
Provider Name (Legal Business Name): AIRRA HAROLDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16723 SE 251ST PL
COVINGTON WA
98042-5230
US

IV. Provider business mailing address

16723 SE 251ST PL
COVINGTON WA
98042-5230
US

V. Phone/Fax

Practice location:
  • Phone: 253-239-3191
  • Fax:
Mailing address:
  • Phone: 253-740-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61493389
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60017434
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: