Healthcare Provider Details

I. General information

NPI: 1841034055
Provider Name (Legal Business Name): TRUE DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 W HOOD PL STE A101
KENNEWICK WA
99336-6720
US

IV. Provider business mailing address

7101 W HOOD PL STE A101
KENNEWICK WA
99336-6720
US

V. Phone/Fax

Practice location:
  • Phone: 509-581-3100
  • Fax: 509-436-1948
Mailing address:
  • Phone: 509-581-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STACEY LEMIRE
Title or Position: PA-C
Credential: PA10004052
Phone: 509-438-0295