Healthcare Provider Details

I. General information

NPI: 1831660893
Provider Name (Legal Business Name): JANELLE SHANNON HYATT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GOETHALS DR STE B
RICHLAND WA
99352
US

IV. Provider business mailing address

550 GAGE BLVD STE 101
RICHLAND WA
99352-9532
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3080
  • Fax: 509-942-3085
Mailing address:
  • Phone: 509-942-3080
  • Fax: 509-942-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60904980
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: