Healthcare Provider Details

I. General information

NPI: 1619998291
Provider Name (Legal Business Name): VERN DEAN COMMET ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S 14TH AVE
YAKIMA WA
98902-3101
US

IV. Provider business mailing address

732 SUMMITVIEW AVE BOX # 611
YAKIMA WA
98902-3032
US

V. Phone/Fax

Practice location:
  • Phone: 509-426-2378
  • Fax: 509-426-2380
Mailing address:
  • Phone: 509-426-2378
  • Fax: 509-426-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30005453
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30005453
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005453
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: