Healthcare Provider Details

I. General information

NPI: 1790600195
Provider Name (Legal Business Name): AMARYLIS THOMPSON BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S CLOVER DR
MOSES LAKE WA
98837-1804
US

IV. Provider business mailing address

3719 W LAKESHORE DR
MOSES LAKE WA
98837-3052
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-5606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: