Healthcare Provider Details

I. General information

NPI: 1295665768
Provider Name (Legal Business Name): ANGEL TYSIA AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 SAINT ANDREWS LOOP STE D
PASCO WA
99301-3378
US

IV. Provider business mailing address

PO BOX 959
YAKIMA WA
98907-0959
US

V. Phone/Fax

Practice location:
  • Phone: 509-412-1051
  • Fax:
Mailing address:
  • Phone: 509-575-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: