Healthcare Provider Details

I. General information

NPI: 1194271866
Provider Name (Legal Business Name): ARIELLE INNES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 RAINIER DR
YAKIMA WA
98908-1535
US

IV. Provider business mailing address

302 RAINIER DR
YAKIMA WA
98908-1535
US

V. Phone/Fax

Practice location:
  • Phone: 518-322-1680
  • Fax: 518-245-3993
Mailing address:
  • Phone: 518-322-1680
  • Fax: 518-245-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402697
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number701273
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: