Healthcare Provider Details

I. General information

NPI: 1881579969
Provider Name (Legal Business Name): VICTORIA LIND PRATT PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3926
US

IV. Provider business mailing address

762 120TH ST S
TACOMA WA
98444-3749
US

V. Phone/Fax

Practice location:
  • Phone: 253-722-1720
  • Fax:
Mailing address:
  • Phone: 661-305-1614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: