Provider Demographics
NPI:1053658724
Name:TIERRA, AMY (ARNP, NP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:TIERRA
Suffix:
Gender:F
Credentials:ARNP, NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-4215
Mailing Address - Country:US
Mailing Address - Phone:360-336-6868
Mailing Address - Fax:360-338-6866
Practice Address - Street 1:1103 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4215
Practice Address - Country:US
Practice Address - Phone:260-336-6868
Practice Address - Fax:360-336-6866
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60331561363LF0000X
WAAP60331561363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily