MEDICARE: BOBBIE BERKEY NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	RN60065162	WA
2	163W00000X	Registered Nurse	RN60065162	WA
3	363LF0000X	Family Nurse Practitioner	AP60912337	WA

General Provider Information

NPI Number	:	1124599667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBIE BERKEY NP-C

Provider Business Mailing Address
First Line	:	1717 JADE AVE
Second Line	:
City	:	LOCHBUIE
State	:	CO
Zip	:	80603-7795
Country	:	US
Telephone Number	:	303-668-8395
Fax Number	:

Provider Business Practice Location Address
First Line	:	4038 11TH AVE NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-2520
Country	:	US
Telephone Number	:	303-668-8395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	03/17/2026

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