Healthcare Provider Details

I. General information

NPI: 1386429603
Provider Name (Legal Business Name): MICAH JAMES SAMUEL FERDEN DNP, ARNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 S 5TH ST FL 4
TACOMA WA
98405-4210
US

IV. Provider business mailing address

4909 WINONA CT NE
TACOMA WA
98422-2073
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-1677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP70133409
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: