Healthcare Provider Details

I. General information

NPI: 1154706190
Provider Name (Legal Business Name): WILLIAM BRENTON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E DIVISION ST
MOUNT VERNON WA
98274-4632
US

IV. Provider business mailing address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

V. Phone/Fax

Practice location:
  • Phone: 360-424-4410
  • Fax:
Mailing address:
  • Phone: 360-428-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60582496
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: