Healthcare Provider Details

I. General information

NPI: 1417008384
Provider Name (Legal Business Name): THERESA SEWELL WINFIELD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESA WINFIELD HICKS

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 POMONA RD
YAKIMA WA
98901-9353
US

IV. Provider business mailing address

1123 POMONA RD
YAKIMA WA
98901-9353
US

V. Phone/Fax

Practice location:
  • Phone: 509-469-6823
  • Fax: 509-241-1841
Mailing address:
  • Phone: 509-469-6823
  • Fax: 509-241-1841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00045172
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30004371
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: