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General NPI Number Information
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NPI Number | 1306116736
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Entity Type | Individual
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Provider Name | ALYSSA KAYLE DERRICK L.M.P.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2012
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Last Update Date | 01/02/2012
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Provider Practice Location Address
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Address Line | 4803 84TH ST SW
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City | MUKILTEO
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State | WA
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Zip | 98275-3023
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Country | US
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Telephone | 425-290-6024
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Fax |
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Provider Business Mailing Address
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Address Line | 5521 186TH PL SW
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City | LYNNWOOD
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State | WA
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Zip | 98037-4325
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Country | US
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Telephone | 425-776-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA60253192
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License Number State | WA
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