=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740042662
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARYYN PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2024
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 E MAIN
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-5698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-325-1121
-----------------------------------------------------
Fax | 800-807-9176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7613 185TH STREET CT E
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98375-9051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-325-1121
-----------------------------------------------------
Fax | 800-807-9176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DOMINIC K KEYA
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 253-325-1121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------