Healthcare Provider Details

I. General information

NPI: 1639897242
Provider Name (Legal Business Name): RACHEL RIDLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 7TH ST SE
PUYALLUP WA
98374-1105
US

IV. Provider business mailing address

2508 7TH ST SE
PUYALLUP WA
98374-1105
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70019380
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11040620
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9339164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: