MEDICARE: PRIDE & JOY GENDER AFFIRMING CARE CLINIC PLLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1134098627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIDE & JOY GENDER AFFIRMING CARE CLINIC PLLC

Provider Business Mailing Address
First Line	:	825 LEGION WAY SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-1586
Country	:	US
Telephone Number	:	253-881-7743
Fax Number	:	253-881-7158

Provider Business Practice Location Address
First Line	:	825 LEGION WAY SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-1586
Country	:	US
Telephone Number	:	253-881-7743
Fax Number	:	253-881-7158

Authorized Official
Title or Position	:	ARNP/OWNER
Name	:	SHANTI HERZOG
Credential	:	ARNP
Telephone Number	:	253-881-7743

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	05/22/2026

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