MEDICARE: RUBY ROSE STOCKING SIAGKRIS MSN ARNP CNM PMHNP

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	367A00000X	Advanced Practice Midwife	AP61046288	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61678118	WA

General Provider Information

NPI Number	:	1629603949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBY ROSE STOCKING SIAGKRIS MSN ARNP CNM PMHNP

Provider Business Mailing Address
First Line	:	1825 LANGRIDGE AVE NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-0707
Country	:	US
Telephone Number	:	541-324-3141
Fax Number	:	360-838-1266

Provider Business Practice Location Address
First Line	:	100 N HOWARD ST STE R
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:	360-564-1942
Fax Number	:	360-838-1266

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

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	01/22/2026

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