Healthcare Provider Details

I. General information

NPI: 1699364505
Provider Name (Legal Business Name): AMIE CHARIE WILCOX APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIE CHARIE PETERS

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 NW MYHRE RD FL 3
SILVERDALE WA
98383-7662
US

IV. Provider business mailing address

1950 NW MYHRE RD
SILVERDALE WA
98383-7662
US

V. Phone/Fax

Practice location:
  • Phone: 564-240-4200
  • Fax: 564-240-4299
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11020775
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61103812
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61103812
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11020775
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP61103812
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: