Healthcare Provider Details

I. General information

NPI: 1235666389
Provider Name (Legal Business Name): NATHAN TOLLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S 5TH ST
MOUNT VERNON WA
98274-3942
US

IV. Provider business mailing address

901 S 5TH ST
MOUNT VERNON WA
98274-3942
US

V. Phone/Fax

Practice location:
  • Phone: 360-814-7300
  • Fax: 360-848-4543
Mailing address:
  • Phone: 360-814-7300
  • Fax: 360-848-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0061698
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOP61220523
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: