MEDICARE: MOONSHOT PSYCHIATRIC NURSE PRACTITIONER PC

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	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1669158879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONSHOT PSYCHIATRIC NURSE PRACTITIONER PC

Provider Business Mailing Address
First Line	:	22406 68TH AVE W
Second Line	:
City	:	MOUNTLAKE TERRACE
State	:	WA
Zip	:	98043-2372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4803 FREMONT AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6527
Country	:	US
Telephone Number	:	855-444-7258
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	BRIGHID GANNON
Credential	:
Telephone Number	:	855-444-7258

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	11/26/2025

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