Healthcare Provider Details

I. General information

NPI: 1689184392
Provider Name (Legal Business Name): MISSY GRIFFITH CARTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISSY G HUTTON

II. Dates (important events)

Enumeration Date: 10/08/2017
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 11TH AVE NE STE 200
SEATTLE WA
98105-6367
US

IV. Provider business mailing address

5123 N 39TH ST
TACOMA WA
98407-3623
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-4001
  • Fax:
Mailing address:
  • Phone: 206-300-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60796670
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA60796670
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: