Healthcare Provider Details

I. General information

NPI: 1366367518
Provider Name (Legal Business Name): JIMMY CALLO ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 WHITESELL ST NW STE B103
ORTING WA
98360-9329
US

IV. Provider business mailing address

215 WHITESELL ST NW STE B103
ORTING WA
98360-9329
US

V. Phone/Fax

Practice location:
  • Phone: 206-304-2720
  • Fax:
Mailing address:
  • Phone: 206-304-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP.AP.70170794-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: