Healthcare Provider Details

I. General information

NPI: 1437185071
Provider Name (Legal Business Name): JOEL A MECKSTROTH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S. 13TH STREET SUITE 300
MOUNT VERNON WA
98274
US

IV. Provider business mailing address

1400 E KINCAID ST ATTN: CREDENTIALING
MOUNT VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-9757
  • Fax: 360-336-2088
Mailing address:
  • Phone: 360-428-2500
  • Fax: 360-428-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAP30004883
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30004883
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: