Healthcare Provider Details

I. General information

NPI: 1588207765
Provider Name (Legal Business Name): TARA HARVEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23745 225TH WAY SE STE 201
MAPLE VALLEY WA
98038-5294
US

IV. Provider business mailing address

3711 164TH ST SW APT Q167
LYNNWOOD WA
98087-7057
US

V. Phone/Fax

Practice location:
  • Phone: 888-674-5871
  • Fax:
Mailing address:
  • Phone: 615-339-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number61010275
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26625
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: