Healthcare Provider Details

I. General information

NPI: 1073666848
Provider Name (Legal Business Name): DAVID JUDE PARIS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 14TH AVE
LONGVIEW WA
98632-2316
US

IV. Provider business mailing address

PO BOX 1847
LONGVIEW WA
98632-8140
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-0203
  • Fax: 360-423-5086
Mailing address:
  • Phone: 360-353-9701
  • Fax: 360-577-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30007147
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: