Healthcare Provider Details

I. General information

NPI: 1619737764
Provider Name (Legal Business Name): SOUTH HILL PAIN & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21701 76TH AVE W STE 104
EDMONDS WA
98026-7536
US

IV. Provider business mailing address

21701 76TH AVE W STE 104
EDMONDS WA
98026-7536
US

V. Phone/Fax

Practice location:
  • Phone: 425-375-5689
  • Fax:
Mailing address:
  • Phone: 425-476-1100
  • Fax: 425-748-7782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ANN BARCLAY
Title or Position: NP/OWNER
Credential: ARNP
Phone: 425-476-1100