Healthcare Provider Details

I. General information

NPI: 1760254007
Provider Name (Legal Business Name): CARRIE OGRADY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HOWARD ST # 5669
SPOKANE WA
99201-0508
US

IV. Provider business mailing address

100 N HOWARD ST # 5669
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 206-504-2489
  • Fax:
Mailing address:
  • Phone: 206-504-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number61498257
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: